Nassar Aziza, Cohen Cynthia, Cotsonis George, Carlson Grant
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Breast J. 2008 Mar-Apr;14(2):147-52. doi: 10.1111/j.1524-4741.2007.00545.x. Epub 2008 Jan 31.
Intramammary lymph nodes (intraMLNs) have received little attention as potential prognostic indicators for patients with breast carcinoma. Patients with stage I breast carcinoma and positive intraMLN metastases have been reported to have a poorer prognosis compared to patients with similar stage and negative intraMLN metastases. However, the presence of intraMLN metastases does not appear to influence the survival of patients with stage II breast carcinoma. In the current retrospective analysis, we assessed the clinical significance of intraMLNs and evaluated their role in predicting outcome in patients with breast carcinoma. Between 1995 and 2005, 116 intraMLN specimens were identified. In all, 59 patients (50.8%) were found in association with benign breast conditions and the remaining 57 (49.2%) with primary breast carcinoma. Primary tumor characteristics and axillary lymph node (AxLN) status were recorded. Outcome data were documented. Statistical analysis was performed to detect correlation between intraMLN and tumor characteristics as well as outcome. IntraMLN metastases were found in 26% of all in-situ and invasive cancer cases (15/57), and 32% (15/47) of invasive cancer cases only. Most patients (80%) who had intraMLN metastases also had axillary metastases; however, an isolated intraMLN metastasis was documented in one patient (7%). Univariate analysis revealed that predictors of intraMLN metastases include: tumor size (p = 0.04), tumor grade (p = 0.04), tumor stage (p < 0.001), and AxLN status (p < 0.001). Furthermore patients with intraMLN positive for metastases have a poorer 4-year overall (40% versus 88%; p < 0.001) and disease-free survival (37% versus 83%; p < 0.001) than patients with negative intraMLN. On multivariate analysis, intraMLN metastasis is not an independent predictor of outcome (disease-free survival: p = 0.350; and overall survival p = 0.138). IntraMLN metastasis is a poor prognostic marker but not an independent predictor of poor outcome in patients with breast carcinoma.
作为乳腺癌患者潜在的预后指标，乳腺内淋巴结（intraMLNs）一直未受到太多关注。据报道，与具有相似分期且乳腺内淋巴结转移阴性的患者相比，I期乳腺癌且乳腺内淋巴结转移阳性的患者预后较差。然而，乳腺内淋巴结转移的存在似乎并不影响II期乳腺癌患者的生存。在当前的回顾性分析中，我们评估了乳腺内淋巴结的临床意义，并评估了它们在预测乳腺癌患者预后中的作用。1995年至2005年间，共识别出116个乳腺内淋巴结标本。其中，59例患者（50.8%）与乳腺良性疾病相关，其余57例（49.2%）与原发性乳腺癌相关。记录了原发肿瘤特征和腋窝淋巴结（AxLN）状态。记录了预后数据。进行统计分析以检测乳腺内淋巴结与肿瘤特征以及预后之间的相关性。在所有原位癌和浸润性癌病例中，26%（15/57）发现有乳腺内淋巴结转移，仅浸润性癌病例中这一比例为32%（15/47）。大多数有乳腺内淋巴结转移的患者（80%）也有腋窝转移；然而，有1例患者（7%）记录为孤立性乳腺内淋巴结转移。单因素分析显示，乳腺内淋巴结转移的预测因素包括：肿瘤大小（p = 0.04）、肿瘤分级（p = 0.04）、肿瘤分期（p < 0.001）和腋窝淋巴结状态（p < 0.001）。此外，乳腺内淋巴结转移阳性的患者4年总生存率（40%对88%；p < 0.001）和无病生存率（37%对83%；p < 0.001）均低于乳腺内淋巴结阴性的患者。多因素分析显示，乳腺内淋巴结转移不是预后的独立预测因素（无病生存率：p = 0.350；总生存率p = 0.138）。乳腺内淋巴结转移是一个不良预后标志物，但不是乳腺癌患者不良预后的独立预测因素。
