Chen Steven L, Hoehne Francesca M, Giuliano Armando E
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA.
Ann Surg Oncol. 2007 Dec;14(12):3378-84. doi: 10.1245/s10434-007-9513-6. Epub 2007 Sep 26.
The prognostic significance of lymph node micrometastases in breast cancer is controversial. We hypothesized that the survival of patients with solely micrometastatic disease (N1mi) would be intermediate to patients with 1-3 tumor-positive lymph nodes (N1) and those with no positive lymph nodes (N0).
We queried the surveillance, epidemiology and end results (SEER) database for all patients between 1992 and 2003 with invasive ductal or lobular breast cancer without distant metastases and < or = 3 axillary nodes with macroscopic disease. Patients were stratified by nodal involvement and compared using the Kaplan-Meier method. Cox proportional hazards regression was utilized to compare survival after adjusting for patient and tumor characteristics.
Between 1992 and 2003, N1mi diagnoses increased from 2.3% to 7% among the 209,720 study patients (p < 0.001). In a T-stage stratified univariate analysis, N1mi patients had a worse prognosis in T2 lesions. On multivariate analysis, N1mi remained a significant prognostic indicator across all patients (p < 0.0001) with a hazard ratio of 1.35 compared to N0 disease and 0.82 compared to N1 disease. Other negative prognostic factors included male gender, estrogen-receptor negativity, progesterone-receptor negativity, lobular histology, higher grade, older age, higher T-stage, and diagnosis in an earlier time period.
Nodal micrometastasis of breast cancer carries a prognosis intermediate to N0 and N1 disease, even after adjusting for tumor- and patient-related factors. Prospective study is warranted and the results of pending trials are highly anticipated. Until then adjuvant therapy trials should consider using N1mi as a stratification factor when determining nodal status.
乳腺癌中淋巴结微转移的预后意义存在争议。我们假设，仅患有微转移疾病（N1mi）的患者的生存率介于有1 - 3个肿瘤阳性淋巴结的患者（N1）和无阳性淋巴结的患者（N0）之间。
我们查询了监测、流行病学和最终结果（SEER）数据库，以获取1992年至2003年间所有患有浸润性导管癌或小叶癌且无远处转移、腋窝淋巴结有肉眼可见疾病且≤3个的患者。患者按淋巴结受累情况分层，并使用Kaplan - Meier方法进行比较。采用Cox比例风险回归来比较在调整患者和肿瘤特征后的生存率。
在1992年至2003年间，209,720名研究患者中N1mi诊断率从2.3%增至7%（p < 0.001）。在T分期分层单因素分析中，N1mi患者在T2病变中的预后较差。在多因素分析中，N1mi在所有患者中仍是一个显著的预后指标（p < 0.0001），与N0疾病相比，风险比为1.35，与N1疾病相比为0.82。其他不良预后因素包括男性、雌激素受体阴性、孕激素受体阴性、小叶组织学、高分级、老年、高T分期以及早期诊断。
即使在调整肿瘤和患者相关因素后，乳腺癌的淋巴结微转移的预后仍介于N0和N1疾病之间。有必要进行前瞻性研究，并且人们高度期待即将进行的试验结果。在此之前，辅助治疗试验在确定淋巴结状态时应考虑将N1mi作为分层因素。
