非炎症性皮肤受累的乳腺癌：一种被低估实体及其分类问题的最新数据。

Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and its problematic classification.

机构信息

University Hospital Basel, Department of Gynecology and Obstetrics, Spitalstrasse 21, Basel, Switzerland.

出版信息

Breast. 2010 Feb;19(1):59-64. doi: 10.1016/j.breast.2009.11.008. Epub 2009 Dec 16.

DOI:10.1016/j.breast.2009.11.008

PMID:20015652

Abstract

We evaluated 166 breast cancer cases with non-inflammatory skin involvement (NISI), which were classified in the TNM classification as T4b. The distribution of tumour sizes and stages was: < or =3 cm:24.1%, 3.1-5 cm:21.7%, 5.1-10 cm:33.1%, >10 cm:21.1%; stages:I/II:21.0%, III:43.4%, IV:35.6%. To assess the impact of NISI on axillary lymph node involvement (ALNI), we analyzed a sub-group of 50 patients with tumours < or =5 cm and compared them with a matched control group. NISI was found to be associated with increased ALNI (HR, 2.66; 95%CI, 1.59-4.63; p<0.0001). According to the inherent rules of tumour classification, only tumours with similar morphologic extent and prognostic significance should be combined. Since there is a high grade of heterogeneity, this basic tenet is clearly violated regarding breast cancer with NISI. Our proposal is to eliminate these tumours from the T4 category and to classify them simply by size (T1-3). Due to its prognostic significance, NISI should be indicated by an optional descriptor (e.g. S1).

摘要

我们评估了 166 例非炎症性皮肤受累（NISI）的乳腺癌病例，这些病例在 TNM 分类中被归类为 T4b。肿瘤大小和分期的分布为：<或=3cm：24.1%，3.1-5cm：21.7%，5.1-10cm：33.1%，>10cm：21.1%；I/II 期：21.0%，III 期：43.4%，IV 期：35.6%。为了评估 NISI 对腋窝淋巴结受累（ALNI）的影响，我们分析了 50 例肿瘤<或=5cm 的患者亚组，并将其与匹配的对照组进行了比较。发现 NISI 与 ALNI 增加相关（HR，2.66；95%CI，1.59-4.63；p<0.0001）。根据肿瘤分类的内在规则，只有具有相似形态学范围和预后意义的肿瘤才应合并。由于存在高度异质性，这一基本原则显然违反了 NISI 乳腺癌的分类。我们的建议是将这些肿瘤从 T4 类别中排除，并仅根据大小（T1-3）进行分类。由于其预后意义，NISI 应由可选描述符（例如 S1）表示。