Pathology Consultation Service, Clinical Trials and Practice Support Division, Center for Cancer Control and Information Services, National Cancer Center Hospital, Tokyo, Japan.
Am J Surg Pathol. 2011 Oct;35(10):1484-97. doi: 10.1097/PAS.0b013e318224ca28.
The pathologic diagnosis is regarded as the final diagnosis of a disease, and pathologic examination based on tumor histology is very important for the accurate assessment of the biological characteristics of tumors. The purpose of this study was to investigate the histologic factors that accurately predict patient outcome among 1042 patients with invasive ductal carcinoma of the breast. Both well-known histologic factors and our proposed histologic factors were examined according to several tumor statuses using multivariate analysis. This study clearly demonstrated that type 4 invasive ductal carcinomas having fibrotic foci and atypical tumor-stromal fibroblasts within the fibrotic foci are significant outcome predictors for lymph node-negative and lymph node-positive, the pathologic UICC-TNM stage II and III, luminal A-subtype, luminal B-subtype, and equivocal HER2 subtype invasive ductal carcinoma patients. Lymph vessel tumor embolus grades 2 and 3 were significant outcome predictors for lymph node-positive, UICC pTNM stages II and III, luminal A-subtype, and triple-negative invasive ductal carcinoma patients (except lymph vessel tumor embolus grade 2 in luminal A-subtype patients). More than 5 mitotic figures in metastatic carcinoma to the lymph nodes was a significant outcome predictor for lymph node-positive, UICC pTNM stage II, and luminal A-subtype invasive ductal carcinoma patients. A fibrotic focus diameter >8 mm was a significant outcome predictor for UICC pTNM stages I and III invasive ductal carcinoma patients. These findings strongly suggest that these histologic factors are very useful for accurately predicting the outcomes of patients with invasive ductal carcinoma of the breast.
病理诊断被视为疾病的最终诊断，基于肿瘤组织学的病理检查对于准确评估肿瘤的生物学特征非常重要。本研究旨在探讨 1042 例浸润性导管癌患者中能够准确预测患者预后的组织学因素。根据多种肿瘤状态，使用多变量分析检查了著名的组织学因素和我们提出的组织学因素。本研究清楚地表明，具有纤维化灶和纤维化灶内非典型肿瘤间质成纤维细胞的 4 型浸润性导管癌是淋巴结阴性和淋巴结阳性、病理 UICC-TNM 分期 II 和 III、腔 A 亚型、腔 B 亚型和HER2 亚型不确定浸润性导管癌患者的显著预后预测因子。淋巴管肿瘤栓子分级 2 和 3 是淋巴结阳性、UICC pTNM 分期 II 和 III、腔 A 亚型和三阴性浸润性导管癌患者（除腔 A 亚型患者的淋巴管肿瘤栓子分级 2 外）的显著预后预测因子。转移性淋巴结癌中超过 5 个有丝分裂象是淋巴结阳性、UICC pTNM 分期 II 和腔 A 亚型浸润性导管癌患者的显著预后预测因子。纤维化灶直径>8mm 是 UICC pTNM 分期 I 和 III 浸润性导管癌患者的显著预后预测因子。这些发现强烈表明，这些组织学因素对于准确预测浸润性导管癌患者的预后非常有用。
