de Boer Maaike, van Deurzen Carolien H M, van Dijck Jos A A M, Borm George F, van Diest Paul J, Adang Eddy M M, Nortier Johan W R, Rutgers Emiel J T, Seynaeve Caroline, Menke-Pluymers Marian B E, Bult Peter, Tjan-Heijnen Vivianne C G
Division of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
N Engl J Med. 2009 Aug 13;361(7):653-63. doi: 10.1056/NEJMoa0904832.
The association of isolated tumor cells and micrometastases in regional lymph nodes with the clinical outcome of breast cancer is unclear.
We identified all patients in The Netherlands who underwent a sentinel-node biopsy for breast cancer before 2006 and had breast cancer with favorable primary-tumor characteristics and isolated tumor cells or micrometastases in the regional lymph nodes. Patients with node-negative disease were randomly selected from the years 2000 and 2001. The primary end point was disease-free survival.
We identified 856 patients with node-negative disease who had not received systemic adjuvant therapy (the node-negative, no-adjuvant-therapy cohort), 856 patients with isolated tumor cells or micrometastases who had not received systemic adjuvant therapy (the node-positive, no-adjuvant-therapy cohort), and 995 patients with isolated tumor cells or micrometastases who had received such treatment (the node-positive, adjuvant-therapy cohort). The median follow-up was 5.1 years. The adjusted hazard ratio for disease events among patients with isolated tumor cells who did not receive systemic therapy, as compared with women with node-negative disease, was 1.50 (95% confidence interval [CI], 1.15 to 1.94); among patients with micrometastases, the adjusted hazard ratio was 1.56 (95% CI, 1.15 to 2.13). Among patients with isolated tumor cells or micrometastases, the adjusted hazard ratio was 0.57 (95% CI, 0.45 to 0.73) in the node-positive, adjuvant-therapy cohort, as compared with the node-positive, no-adjuvant-therapy cohort.
Isolated tumor cells or micrometastases in regional lymph nodes were associated with a reduced 5-year rate of disease-free survival among women with favorable early-stage breast cancer who did not receive adjuvant therapy. In patients with isolated tumor cells or micrometastases who received adjuvant therapy, disease-free survival was improved.
区域淋巴结中孤立肿瘤细胞和微转移与乳腺癌临床结局之间的关联尚不清楚。
我们确定了荷兰所有在2006年前接受前哨淋巴结活检的乳腺癌患者，这些患者具有良好的原发性肿瘤特征且区域淋巴结中有孤立肿瘤细胞或微转移。2000年和2001年随机选取了无淋巴结转移疾病的患者。主要终点是无病生存期。
我们确定了856例未接受全身辅助治疗的无淋巴结转移疾病患者（无淋巴结转移、未接受辅助治疗队列），856例有孤立肿瘤细胞或微转移且未接受全身辅助治疗的患者（有淋巴结转移、未接受辅助治疗队列），以及995例有孤立肿瘤细胞或微转移且接受了此类治疗的患者（有淋巴结转移、辅助治疗队列）。中位随访时间为5.1年。与无淋巴结转移疾病的女性相比，未接受全身治疗的有孤立肿瘤细胞患者发生疾病事件的校正风险比为1.50（95%置信区间[CI]，1.15至1.94）；有微转移的患者，校正风险比为1.56（95%CI，1.15至2.13）。与有淋巴结转移、未接受辅助治疗队列相比，有淋巴结转移、辅助治疗队列中有孤立肿瘤细胞或微转移的患者校正风险比为0.57（95%CI，0.45至0.73）。
区域淋巴结中的孤立肿瘤细胞或微转移与未接受辅助治疗的早期乳腺癌预后良好女性的5年无病生存率降低有关。在接受辅助治疗的有孤立肿瘤细胞或微转移的患者中，无病生存期得到改善。
