Pathology Consultation Service, Clinical Trials and Practice Support Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
Mod Pathol. 2010 Apr;23(4):581-92. doi: 10.1038/modpathol.2010.3. Epub 2010 Jan 29.
The purpose of this study was to confirm that the grades of lymph vessel tumor emboli in biopsy specimens obtained before neoadjuvant therapy and in the surgical specimens obtained after neoadjuvant therapy according to the grading system we devised are significant histological outcome predictor for invasive ductal carcinoma (IDC) patients who received neoadjuvant therapy. The subjects of this study were the 318 consecutive IDC patients who had received neoadjuvant therapy in our institution. The lymph vessel tumor embolus grades in the biopsy specimens and in the surgical specimens were significantly associated with the increases in mean number of nodal metastases. Multivariate analyses with well-known prognostic factors and p53 expression in tumor-stromal fibroblasts clearly showed that the lymph vessel tumor embolus grade based on the biopsy specimens and based on the surgical specimens significantly increased the hazard rates for tumor recurrence and tumor-related death in all the IDC patients as a whole, in the IDC patients who did not have nodal metastasis, and in the IDC patients who had nodal metastasis, and the outcome-predictive power of the lymph vessel tumor embolus grades based on the surgical specimens was superior to that of the lymph vessel tumor embolus grades based on the biopsy specimens. The grades in the grading system for lymph vessel tumor emboli were significantly associated with nodal metastasis, and the histological grading system is an excellent system for accurately predicting the outcome of patients with IDC of the breast who have received neoadjuvant therapy.
本研究的目的在于证实，根据我们设计的分级系统，新辅助治疗前活检标本和新辅助治疗后手术标本中的淋巴管肿瘤栓子分级，是接受新辅助治疗的浸润性导管癌（IDC）患者具有显著组织学预后预测价值的因素。本研究的对象是 318 例在我院接受新辅助治疗的连续 IDC 患者。活检标本和手术标本中的淋巴管肿瘤栓子分级与平均淋巴结转移数的增加显著相关。将已知的预后因素和肿瘤间质成纤维细胞中 p53 的表达进行多变量分析后，明确显示，基于活检标本和手术标本的淋巴管肿瘤栓子分级显著增加了所有 IDC 患者、无淋巴结转移的 IDC 患者和有淋巴结转移的 IDC 患者的肿瘤复发和肿瘤相关死亡风险比，且基于手术标本的淋巴管肿瘤栓子分级的预后预测能力优于基于活检标本的淋巴管肿瘤栓子分级。淋巴管肿瘤栓子分级与淋巴结转移显著相关，该分级系统是一种准确预测接受新辅助治疗的 IDC 患者预后的优秀系统。
