Hasebe Takahiro, Imoto Shigeru, Yokose Tomoyuki, Ishii Gen-Ichiro, Iwasaki Motoki, Wada Noriaki
Surgical Pathology Section, Clinical Laboratory Division, National Cancer Center Hospital East, Kashiwa, Chiba 277-0882, Japan.
Hum Pathol. 2008 May;39(5):681-93. doi: 10.1016/j.humpath.2007.09.012. Epub 2008 Mar 10.
The purpose of this study was to identify histologic factors significantly associated with initial organ-specific metastasis by 1044 invasive ductal carcinomas (IDCs) of the breast with and without adjuvant therapy, separately, according to nodal status and pathologic TNM stage status. The following histologic factors were prospectively analyzed by multivariate analyses for distant organ metastasis and bone metastasis in patients with IDC who did not receive adjuvant therapy, and for distant organ metastasis, bone metastasis, liver metastasis, and lung metastasis in patients with IDC who received adjuvant therapy: (1) invasive tumor size, (2) histologic grade, (3) tumor necrosis, (4) fibrotic focus (FF), (5) lymphatic invasion, (6) blood vessel invasion, (7) adipose tissue invasion, (8) skin invasion, (9) muscle invasion, (10) age, (11) estrogen (ER)/progesterone (PR) status, and (12) nodal status. The results showed that FF diameter greater than 8 mm and FF fibrosis grade 1 were the factors that most accurately predicted distant organ metastasis and bone metastasis in patients with IDC who did not receive adjuvant therapy. In patients with IDC who received adjuvant therapy, FF diameter greater than 8 mm was the factor that most accurately predicted bone metastasis, and the presence of tumor necrosis and ER-/PR- were very important predictive factors for metastasis to the lung. Ten or more nodal metastases (N3) were the factor that most accurately predicted liver metastasis. Based on these findings, FF characteristics can be concluded to be the most important histologic factors for predicting metastasis to the bone, the presence of tumor necrosis and ER-/PR- for predicting metastasis to the lung, and N3 for predicting metastasis to the liver.
本研究的目的是根据淋巴结状态和病理TNM分期，分别确定1044例接受和未接受辅助治疗的乳腺浸润性导管癌（IDC）中与初始器官特异性转移显著相关的组织学因素。对未接受辅助治疗的IDC患者的远处器官转移和骨转移，以及接受辅助治疗的IDC患者的远处器官转移、骨转移、肝转移和肺转移，通过多因素分析对以下组织学因素进行前瞻性分析：（1）浸润性肿瘤大小，（2）组织学分级，（3）肿瘤坏死，（4）纤维化灶（FF），（5）淋巴管浸润，（6）血管浸润，（7）脂肪组织浸润，（8）皮肤浸润，（9）肌肉浸润，（10）年龄，（11）雌激素（ER）/孕激素（PR）状态，以及（12）淋巴结状态。结果显示，FF直径大于8 mm且FF纤维化分级为1级是未接受辅助治疗的IDC患者远处器官转移和骨转移最准确的预测因素。在接受辅助治疗的IDC患者中，FF直径大于8 mm是骨转移最准确的预测因素，肿瘤坏死的存在以及ER-/PR-是肺转移非常重要的预测因素。10个或更多的淋巴结转移（N3）是肝转移最准确的预测因素。基于这些发现，可以得出结论，FF特征是预测骨转移最重要的组织学因素，肿瘤坏死的存在以及ER-/PR-是预测肺转移的因素，N3是预测肝转移的因素。
