Purdom Mathew, Cibull Michael L, Stratton Terry D, Samayoa Luis M, Romond Edward H, McGrath Patrick C, Karabakhtsian Rouzan G
Department of Pathology & Laboratory Medicine, Chandler Medical Center, College of Medicine, University of Kentucky, 800 Rose Street, MS 129, Lexington, KY 40536, USA.
Patholog Res Int. 2010 Oct 26;2011:825627. doi: 10.4061/2011/825627.
Prognosis of invasive ductal carcinoma (IDC) strongly correlates with tumor grade as determined by Nottingham combined histologic grade. While reporting grade as low grade/favorable (G1), intermediate grade/moderately favorable (G2), and high grade/unfavorable (G3) is recommended by American Joint Committee on Cancer (AJCC) staging system, existing TNM (Primary Tumor/Regional Lymph Nodes/Distant Metastasis) classification does not directly incorporate these data. For large tumors (T3, T4), significance of histologic grade may be clinically moot as those are nearly always candidates for adjuvant therapy. However, for small (T1, T2) node-negative (N0) tumors, grade may be clinically relevant in influencing treatment decisions, but data on outcomes are sparse and controversial. This retrospective study analyzes clinical outcome in patients with small N0 IDC on the basis of tumor grade. Our results suggest that the grade does not impact clinical outcome in T1N0 tumors. In T2N0 tumors, however, it might be prognostically significant and relevant in influencing decisions regarding the need for additional adjuvant therapy and optimal management.
浸润性导管癌（IDC）的预后与诺丁汉联合组织学分级所确定的肿瘤分级密切相关。虽然美国癌症联合委员会（AJCC）分期系统建议将分级报告为低级别/预后良好（G1）、中级/中度预后良好（G2）和高级别/预后不良（G3），但现有的TNM（原发肿瘤/区域淋巴结/远处转移）分类并未直接纳入这些数据。对于大肿瘤（T3、T4），组织学分级的意义在临床上可能没有实际意义，因为这些肿瘤几乎总是辅助治疗的候选对象。然而，对于小（T1、T2）、无淋巴结转移（N0）的肿瘤，分级在影响治疗决策方面可能具有临床相关性，但关于预后的数据稀少且存在争议。这项回顾性研究基于肿瘤分级分析了小N0 IDC患者的临床结局。我们的结果表明，分级对T1N0肿瘤的临床结局没有影响。然而，在T2N0肿瘤中，分级可能具有预后意义，并且在影响关于是否需要额外辅助治疗和最佳管理的决策方面具有相关性。
