Joensuu H, Toikkanen S, Klemi P J
Department of Radiotherapy, Turku University Central Hospital, Finland.
Cancer. 1990 Jul 15;66(2):331-40. doi: 10.1002/1097-0142(19900715)66:2<331::aid-cncr2820660222>3.0.co;2-6.
The prognostic significance of DNA ploidy, DNA index (DI), and S-phase fraction (SPF) and their various combinations were studied together with 16 other clinicopathologic factors in 222 patients with operable invasive ductal breast carcinoma. The patients have been followed for a minimum of 22 years after the diagnosis or until death. Nuclear DNA content was determined by flow cytometry from paraffin-embedded tissue. Patients with DNA diploid cancer (n = 57, 26%) had better survival rate corrected for intercurrent deaths than patients with nondiploid cancer (P = 0.002), and also, a small SPF (less than or equal to 14%, calculated in 134 cases) was associated with a favorable outcome in a univariate analysis (P = 0.01). The prognostic value of the DI and SPF was increased if they were combined. The most effective combination was obtained if diploid cancers were grouped together with DNA aneuploid cancers with a DI less than 2.1 and an SPF less than 14%. This combination had considerable prognostic value in a univariate analysis (P = 0.0002) and had independent prognostic value (P = 0.04) in Cox's multivariate analysis together with the primary tumor size (P less than 0.001) in axillary node negative patients but not in axillary node positive patients. In the whole series the presence of axillary nodal metastases (P less than 0.001), high mitotic count (P less than 0.001), a large primary tumor size (P = 0.001), poorly circumscribed tumor margin (P = 0.005), and slight or absent tubule formation (P = 0.05) were the only independent prognostic factors in a multivariate analysis.
在222例可手术切除的浸润性导管癌患者中，研究了DNA倍体、DNA指数（DI）和S期细胞分数（SPF）及其各种组合与其他16种临床病理因素的预后意义。自诊断后，对患者进行了至少22年的随访，直至死亡。通过对石蜡包埋组织进行流式细胞术测定核DNA含量。DNA二倍体癌患者（n = 57，26%）校正并发死亡后的生存率高于非二倍体癌患者（P = 0.002），而且，在单因素分析中，小的SPF（小于或等于14%，在134例中计算）与良好预后相关（P = 0.01）。如果将DI和SPF结合起来，其预后价值会增加。如果将二倍体癌与DI小于2.1且SPF小于14%的DNA非整倍体癌归为一组，可得到最有效的组合。在单因素分析中，这种组合具有相当大的预后价值（P = 0.0002），在Cox多因素分析中，与腋窝淋巴结阴性患者的原发肿瘤大小（P < 0.001）一起具有独立的预后价值（P = 0.04），但在腋窝淋巴结阳性患者中则不然。在整个系列中，腋窝淋巴结转移（P < 0.001）、高有丝分裂计数（P < 0.001）、大的原发肿瘤大小（P = 0.001）、肿瘤边界不清（P = 0.005）以及轻微或无小管形成（P = 0.05）是多因素分析中仅有的独立预后因素。
