Truong Pauline T, Vinh-Hung Vincent, Cserni Gabor, Woodward Wendy A, Tai Patricia, Vlastos Georges
Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada.
Eur J Cancer. 2008 Aug;44(12):1670-7. doi: 10.1016/j.ejca.2008.05.011. Epub 2008 Jul 1.
To evaluate the prognostic impact of the number of positive nodes and the lymph node ratio (LNR) of positive to excised nodes on survival in women diagnosed with nodal micrometastatic breast cancer before the era of widespread sentinel lymph node biopsy.
Subjects were 62,551 women identified by the Surveillance Epidemiology and End Results database, diagnosed with pT1-2pN0-1 breast cancer between 1988 and 1997. Kaplan-Meier breast cancer-specific survival (BCSS) and overall survival (OS) were compared between three cohorts: node-negative (pN0, n=57,980) nodal micrometastasis all <or=2mm (pNmic, N=1818), and macroscopic nodal metastasis >2mm but <2 cm (pNmac, n=2753). Nodal subgroups were examined by the number of positive nodes (1-3 versus >or= 4) and the LNR (<or=0.25 versus >0.25).
Median follow-up was 7.3 yr. Ten-year BCSS and OS in pNmic breast cancer were significantly lower compared to pN0 disease (BCSS 82.3% versus 91.9%, p<0.001 and OS 68.1% versus 75.7%, p<0.001). BCSS and OS with pNmic disease progressively declined with increasing number of positive nodes and increasing LNR. OS with pNmic was similar to pNmac disease when matched by the number of positive nodes and by the LNR. Both pN-based and LNR-based classifications were significantly prognostic of BCSS and OS on Cox regression multivariate analysis.
Nodal micrometastasis is associated with poorer survival compared to pN0 disease. Mortality hazards with nodal micrometastasis increased with increasing number of positive nodes and increasing LNR. The number of positive nodes and the LNR should be considered in risk estimates for patients with nodal micrometastatic breast cancer.
在广泛开展前哨淋巴结活检时代之前，评估阳性淋巴结数量和阳性淋巴结与切除淋巴结的比例（LNR）对诊断为淋巴结微转移乳腺癌的女性患者生存的预后影响。
研究对象为通过监测、流行病学和最终结果数据库确定的62551名女性，她们在1988年至1997年间被诊断为pT1-2pN0-1乳腺癌。比较了三个队列的Kaplan-Meier乳腺癌特异性生存率（BCSS）和总生存率（OS）：淋巴结阴性（pN0，n = 57980）、淋巴结微转移均≤2mm（pNmic，N = 1818）以及肉眼可见淋巴结转移>2mm但<2cm（pNmac，n = 2753）。通过阳性淋巴结数量（1 - 3个与≥4个）和LNR（≤0.25与>0.25）对淋巴结亚组进行检查。
中位随访时间为7.3年。与pN0疾病相比，pNmic乳腺癌的10年BCSS和OS显著更低（BCSS：82.3%对91.9%，p<0.001；OS：68.1%对75.7%，p<0.001）。pNmic疾病的BCSS和OS随着阳性淋巴结数量增加和LNR升高而逐渐下降。当按阳性淋巴结数量和LNR匹配时，pNmic的OS与pNmac疾病相似。在Cox回归多变量分析中，基于pN和基于LNR的分类对BCSS和OS均具有显著的预后意义。
与pN0疾病相比，淋巴结微转移与较差的生存率相关。淋巴结微转移的死亡风险随着阳性淋巴结数量增加和LNR升高而增加。对于淋巴结微转移乳腺癌患者的风险评估，应考虑阳性淋巴结数量和LNR。
