Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA
J Clin Oncol. 2011 Jul 1;29(19):2628-34. doi: 10.1200/JCO.2010.32.1877. Epub 2011 May 23.
To evaluate the clinical outcomes and relationship between tumor size, lymph node status, and prognosis in a large cohort of patients with confirmed triple receptor-negative breast cancer (TNBC).
We reviewed 1,711 patients with TNBC diagnosed between 1980 and 2009. Patients were categorized by tumor size and nodal status. Kaplan-Meier product limit method was used to calculate overall survival (OS) and relapse-free survival (RFS). A Sidak adjustment was used for multiple group comparisons. Cox proportional hazards models were fit to determine the association of tumor size and nodal status with survival outcomes after adjustment for other patient and disease characteristics.
Median age was 48 years (range, 21 to 87 years). At a median follow-up of 53 months (range, 0.7 to 317 months), there were 614 deaths and 747 recurrences. The 5-year OS was 80% for node-negative patients (N0), 65% for one to three positive lymph nodes (N1), 48% for four to nine positive lymph nodes (N2), and 44% for ≥ 10 positive lymph nodes (N3; P < .0001). The 5-year RFS rates were 67% for N0, 52% for N1, 36% for N2, and 33% for N3 (P < .0001). Pairwise comparison by nodal status showed that when comparing N0 with node-positive disease, there was a significant difference in OS and RFS (P < .001 all comparisons). However, when comparing N1 with N2 and N3 disease regardless of tumor size, there were no significant differences in OS or RFS.
In patients with TNBC, once there is evidence of lymph node metastasis, the prognosis may not be affected by the number of positive lymph nodes.
评估大样本三阴性乳腺癌（TNBC）患者的临床结局及肿瘤大小、淋巴结状态与预后的关系。
我们回顾了 1980 年至 2009 年间确诊的 1711 例 TNBC 患者。根据肿瘤大小和淋巴结状态对患者进行分类。采用 Kaplan-Meier 乘积限法计算总生存（OS）和无复发生存（RFS）。采用 Sidak 调整法进行多组比较。采用 Cox 比例风险模型确定在调整其他患者和疾病特征后，肿瘤大小和淋巴结状态与生存结局的相关性。
中位年龄为 48 岁（范围，21 至 87 岁）。中位随访时间为 53 个月（范围，0.7 至 317 个月），有 614 例死亡和 747 例复发。无淋巴结转移（N0）患者的 5 年 OS 率为 80%，1 至 3 个阳性淋巴结（N1）为 65%，4 至 9 个阳性淋巴结（N2）为 48%，≥ 10 个阳性淋巴结（N3）为 44%（P<0.0001）。N0、N1、N2 和 N3 的 5 年 RFS 率分别为 67%、52%、36%和 33%（P<0.0001）。按淋巴结状态进行两两比较，N0 与阳性淋巴结疾病相比，OS 和 RFS 差异有统计学意义（所有比较 P<0.001）。然而，N1 与 N2 和 N3 疾病（无论肿瘤大小如何）相比，OS 和 RFS 差异无统计学意义。
在 TNBC 患者中，一旦存在淋巴结转移证据，预后可能不受阳性淋巴结数量的影响。
