Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):793-8. doi: 10.1016/j.ijrobp.2009.08.049. Epub 2010 Feb 18.
To examine the relationship between lymphovascular invasion (LVI) and regional nodal failure (RNF) in breast cancer patients with zero to three positive nodes treated with breast-conservation therapy (BCT).
The records of 1,257 breast cancer patients with zero to three positive lymph nodes were reviewed. All patients were treated with BCT at Massachusetts General Hospital from 1980 to December 2003. Lymphovascular invasion was diagnosed by hematoxylin and eosin-stained sections and in some cases supported by immunohistochemical stains. Regional nodal failure was defined as recurrence in the ipsilateral supraclavicular, axillary, or internal mammary lymph nodes. Regional nodal failure was diagnosed by clinical and/or radiologic examination.
The median follow-up was 8 years (range, 0.1-21 years). Lymphovascular invasion was present in 211 patients (17%). In univariate analysis, patients with LVI had a higher rate of RNF (3.32% vs. 1.15%; p = 0.02). In multivariate analysis, only tumor size, grade, and local failure were significant predictors of RNF (p = 0.049, 0.013, and 0.0001, respectively), whereas LVI did not show a significant relationship with RNF (hazard ratio = 2.07; 95% CI, 0.8-5.5; p = 0.143). The presence of LVI in the T2/3 population did not increase the risk of RNF over that for those with no LVI (p = 0.15). In addition, patients with Grade 3 tumors and positive LVI did not have a higher risk of RNF than those without LVI (p = 0.96).
These results suggest that LVI can not be used as a sole indicator for regional nodal irradiation in breast cancer patients with zero to three positive lymph nodes treated with BCT.
研究行保乳治疗（BCT）的零至三阳性淋巴结乳腺癌患者中，淋巴血管侵犯（LVI）与区域淋巴结失败（RNF）之间的关系。
回顾了 1257 例零至三阳性淋巴结乳腺癌患者的记录。所有患者于 1980 年至 2003 年 12 月在马萨诸塞州总医院接受 BCT。通过苏木精和伊红染色切片诊断淋巴血管侵犯，在某些情况下，通过免疫组织化学染色支持诊断。区域淋巴结失败定义为同侧锁骨上、腋窝或内乳淋巴结的复发。区域淋巴结失败通过临床和/或放射学检查诊断。
中位随访时间为 8 年（范围，0.1-21 年）。211 例（17%）患者存在 LVI。在单因素分析中，LVI 患者 RNF 发生率较高（3.32%比 1.15%；p = 0.02）。在多因素分析中，只有肿瘤大小、分级和局部失败是 RNF 的显著预测因素（p = 0.049、0.013 和 0.0001），而 LVI 与 RNF 无显著关系（危险比=2.07；95%CI，0.8-5.5；p = 0.143）。T2/3 人群中 LVI 的存在并未增加 RNF 的风险，超过无 LVI 患者（p = 0.15）。此外，LVI 阳性且分级为 3 级的肿瘤患者 RNF 风险并不高于无 LVI 的患者（p = 0.96）。
这些结果表明，在接受 BCT 的零至三阳性淋巴结乳腺癌患者中，LVI 不能作为区域淋巴结照射的唯一指标。
