腋窝淋巴结转移阳性率可预测非转移性乳腺癌患者的生存率。

Percent positive axillary lymph node metastasis predicts survival in patients with non-metastatic breast cancer.

作者信息

Lale Atahan Ibtisam, Yildiz Ferah, Ozyigit Gokhan, Sari Sait, Gurkaynak Murat, Selek Ugur, Hayran Mutlu

机构信息

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sohhiye, Ankara, Turkey.

出版信息

Acta Oncol. 2008;47(2):232-8. doi: 10.1080/02841860701678761.

DOI:10.1080/02841860701678761

PMID:17924207

Abstract

PURPOSE

We retrospectively evaluated the impact of percent positive axillary nodal involvement on the therapeutic outcomes in patients with non-metastatic breast cancer receiving postmastectomy radiotherapy and chemotherapy.

MATERIALS AND METHODS

Between January 1994 and December 2002, the medical records of 939 eligible non metastatic breast carcinoma patients were analyzed. Chest wall radiotherapy was indicated in case of positive surgical margin, tumor size equal or more than 4 cm, skin-fascia invasion. Lymphatic irradiation was applied for more than three metastatic axillary lymph nodes, incomplete axillary dissection (<10 lymph nodes), extracapsular extension or perinodal fat tissue invasion. A total dose of 50 Gy was given to chest wall and lymph node regions with 2 Gy daily fractions. Statistical analyses were performed by Kaplan-Meier method, Log-rank test and Cox's regression analysis.

RESULTS

The median follow-up for all patients alive was 62 months. The 5-year overall survival (OS) and disease-free survival (DFS) for entire cohort were 81%, and 65%, respectively. Univariate analysis for OS revealed significance for tumour size (< or =5 cm vs. >5 cm, p<0.001), metastatic nodal involvement (0 vs. 1-3 vs. >4 LN, p<0.001), percent positive nodal involvement ([metastatic nodes/total nodes removed] x 100; 0 vs. < or =25% vs. 26-50% vs. >50%, p<0.001), surgical margin status (negative vs. positive, p=0.05), and hormonal treatment (present vs. absent, p=0.03). DFS had similarly significance for age (< or =40 years vs. >40 years, p=0.006), tumour size (0.02), metastatic nodal involvement (p<0.001), percent positive nodal involvement (p<0.001), and perinodal invasion (present vs. absent, p=0.01). Multivariate analysis revealed significance for tumour size, percent positive nodal involvement, hormonal treatment, and surgical margin status for OS. Age and percent positive nodal involvement were found to be significant for DFS.

CONCLUSION

Percent positive nodal involvement was found to be a significant prognostic factor for survival in all end-points.

摘要

目的

我们回顾性评估了腋窝淋巴结转移阳性率对接受乳房切除术后放疗和化疗的非转移性乳腺癌患者治疗结果的影响。

材料与方法

分析1994年1月至2002年12月期间939例符合条件的非转移性乳腺癌患者的病历。手术切缘阳性、肿瘤大小等于或大于4 cm、皮肤筋膜侵犯的情况下需进行胸壁放疗。腋窝淋巴结转移超过3个、腋窝清扫不彻底（<10个淋巴结）、包膜外侵犯或结周脂肪组织侵犯时需进行淋巴引流区照射。胸壁和淋巴结区域给予总剂量50 Gy，每日分次剂量为2 Gy。采用Kaplan-Meier法、Log-rank检验和Cox回归分析进行统计分析。

结果

所有存活患者的中位随访时间为62个月。整个队列的5年总生存率（OS）和无病生存率（DFS）分别为81%和65%。OS的单因素分析显示，肿瘤大小（≤5 cm与>5 cm，p<0.001）、转移性淋巴结受累情况（0个与1 - 3个与>4个淋巴结，p<0.001）、淋巴结转移阳性率（[转移淋巴结数/切除的总淋巴结数]×100；0与≤25%与26 - 50%与>50%，p<0.001）、手术切缘状态（阴性与阳性，p = 0.05）以及激素治疗（有与无，p = 0.03）具有统计学意义。DFS在年龄（≤40岁与>40岁，p = 0.006）、肿瘤大小（p = 0.02）、转移性淋巴结受累情况（p<0.001）、淋巴结转移阳性率（p<0.001）以及结周侵犯（有与无，p = 0.01）方面同样具有统计学意义。多因素分析显示，肿瘤大小、淋巴结转移阳性率、激素治疗以及手术切缘状态对OS具有统计学意义。年龄和淋巴结转移阳性率对DFS具有统计学意义。