Biomarkers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Int J Biol Markers. 2013 Apr 23;28(1):24-31. doi: 10.5301/JBM.2013.10574.
The present study investigated whether tumor markers such as cell proliferation and steroid receptor status, which have been shown to have relevance for important endpoints (relapse-free and overall survival), can also predict axillary disease in elderly patients with breast cancer. We evaluated 351 consecutive elderly women with breast cancer ≥70 years of age with estrogen receptor (ER)‑positive tumors with no palpable axillary nodes, for whom information on cell proliferation determined by the 3H-thymidine labeling index (TLI) and progesterone receptor (PgR) was available. Patients underwent quadrantectomy (70.1%) or quadrantectomy plus radiotherapy (29.9%) without axillary node dissection, followed by adjuvant tamoxifen for at least 2 years. Univariable (cumulative incidence curves) and multivariable analyses (Fine and Gray models) were carried out. After a median follow-up of 16 years, ipsilateral axillary relapse was not related to PgR status but was strongly associated with tumor cell proliferation in both small (pT1) and large (pT2-4b) tumors. Axillary relapse cumulative incidence increased from 1% in patients with low-TLI (≤3%), PgR-positive and pT1 tumors to a maximum of 20% in patients with high-TLI, PgR-negative and pT2-4b tumors. Tumor cell proliferation, determined by TLI at primary surgery, is an important predictor of axillary relapse in elderly ER-positive breast cancer patients and could help to identify patients who should undergo axillary surgery.
本研究旨在探讨细胞增殖和甾体受体状态等肿瘤标志物是否与重要终点（无病生存期和总生存期）相关，是否也可预测老年乳腺癌患者的腋窝疾病。我们评估了 351 例连续的年龄≥70 岁、雌激素受体（ER）阳性、无可触及腋窝淋巴结且肿瘤增殖情况可通过 3H-胸腺嘧啶标记指数（TLI）和孕激素受体（PgR）检测的乳腺癌老年女性患者。所有患者均接受了象限切除术（70.1%）或象限切除术加放疗（29.9%），而未行腋窝淋巴结清扫术，之后接受至少 2 年的辅助他莫昔芬治疗。我们进行了单变量（累积发病率曲线）和多变量分析（Fine 和 Gray 模型）。在中位随访 16 年后，同侧腋窝复发与 PgR 状态无关，但与小肿瘤（pT1）和大肿瘤（pT2-4b）中肿瘤细胞增殖密切相关。腋窝复发的累积发病率从低 TLI（≤3%）、PgR 阳性和 pT1 肿瘤患者的 1%增加到高 TLI、PgR 阴性和 pT2-4b 肿瘤患者的 20%。原发手术时 TLI 确定的肿瘤细胞增殖是老年 ER 阳性乳腺癌患者腋窝复发的重要预测因子，有助于确定应行腋窝手术的患者。
