乳腺癌腋窝淋巴结转移的病理和免疫组织化学参数的预测价值。
Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma.
机构信息
Department of Pathology, Fatih University Hospital, Ankara, Turkey.
出版信息
Diagn Pathol. 2011 Mar 13;6:18. doi: 10.1186/1746-1596-6-18.
BACKGROUND/OBJECTIVE: While several prognostic factors have been identified in breast carcinoma, the clinical outcome remains hard to predict for individual patients. Better predictive markers are needed to help guide difficult treatment decisions. Axillary lymph node metastasis (ALNM) is one of the most important prognostic determinants in breast carcinoma; however, the reasons why tumors vary in their capability to result in axillary metastasis remain unclear. Identifying breast carcinoma patients at risk for ALNM would improve treatment planning. This study aimed to identify the factors associated with ALNM in breast carcinoma, with particular emphasis on basal-like phenotype.
METHODS
Breast carcinoma patients (n = 210) who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy were included in this study. Pathological and immunohistochemical data including individual receptor/gene status was collected for analysis. The basal phenotype status was ascertained using the basal cytokeratin markers CK5, CK14, CK17 and EGFR.
RESULTS
ALNM was found in 55% (n = 116) of the patients. On univariate analysis, multicentric disease, large tumor size (>2 cm), vascular and lymphatic invasion, epithelial hyperplasia, necrosis, in situ carcinoma and perineural invasion were associated with higher risk for ALNM, whereas CK5, CK14, EGFR positivity and basal-like tumor type were associated with lower risk. On multivariate analysis, CK5 positivity (OR 0.003, 95%CI 0.000-0.23, p = 0.009) and lymphatic/vascular invasion (OR 17.94, 95%CI 4.78-67.30, p < 0.001) were found to be independent predictors.
CONCLUSIONS
Although the value of complete ALND has been questioned in invasive breast cancer patients, treatment decisions for breast carcinoma have been influenced by many parameters, including lymph node status. Since histopathologic characteristics and expression of biological markers varies among the same histologic subtypes of breast carcinoma, specific clinical and histopathologic features of the primary tumor and ALN status like sentinel node might be used to tailor the loco-regional and systemic treatment in different clinical settings.
背景/目的：虽然已经确定了几种乳腺癌的预后因素，但个体患者的临床预后仍然难以预测。需要更好的预测标志物来帮助指导困难的治疗决策。腋窝淋巴结转移（ALNM）是乳腺癌最重要的预后决定因素之一；然而，肿瘤在导致腋窝转移能力方面存在差异的原因尚不清楚。确定有 ALNM 风险的乳腺癌患者将改善治疗计划。本研究旨在确定乳腺癌中与 ALNM 相关的因素，特别强调基底样表型。
方法
本研究纳入了 210 例接受保乳手术和腋窝淋巴结清扫术（I 级和 II 级）或改良根治性乳房切除术的乳腺癌患者。收集了包括个体受体/基因状态在内的病理和免疫组织化学数据进行分析。基底表型状态通过基底细胞角蛋白标志物 CK5、CK14、CK17 和 EGFR 来确定。
结果
55%（n=116）的患者发生了 ALNM。单因素分析显示，多中心疾病、肿瘤较大（>2cm）、血管和淋巴管浸润、上皮增生、坏死、原位癌和神经周围浸润与更高的 ALNM 风险相关，而 CK5、CK14、EGFR 阳性和基底样肿瘤类型与更低的风险相关。多因素分析显示，CK5 阳性（OR 0.003，95%CI 0.000-0.23，p=0.009）和淋巴管/血管浸润（OR 17.94，95%CI 4.78-67.30，p<0.001）是独立的预测因素。
结论
尽管完整 ALND 的价值在浸润性乳腺癌患者中受到质疑，但乳腺癌的治疗决策受到许多参数的影响，包括淋巴结状态。由于组织病理学特征和生物标志物的表达在乳腺癌的相同组织学亚型中存在差异，因此原发肿瘤的特定临床和组织病理学特征以及 ALN 状态（如前哨淋巴结）可能用于根据不同的临床情况调整局部和全身治疗。
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