Department of Surgery, Lindenhof Hospital, Berne, Switzerland.
Ann Surg Oncol. 2014 Feb;21(2):401-7. doi: 10.1245/s10434-013-3315-9. Epub 2013 Oct 22.
The presence of lymph node metastases is the most important prognostic factor in early stage breast cancer. Whether bone marrow micrometastases (BMM) impact the prognosis in sentinel lymph node (SLN)-negative breast cancer patients remains a matter of debate. Therefore, the objective of this study was to assess the impact of BMM on 5-year disease-free and overall survival among those patients.
We analyzed 410 patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, cN0) who were prospectively enrolled into the Swiss Multicenter Sentinel Lymph Node Study in Breast Cancer between January 2000 and December 2003. All patients underwent bone marrow aspiration followed by SLN biopsy. All SLN were stained with hematoxylin and eosin and immunohistochemistry (Lu-5, CK-22). Cancer cells in the bone marrow were identified after staining with monoclonal antibodies A45-B/B3 against CK-8, -18, and -19.
Negative SLN were found in 67.6% (277 of 410) of the enrolled patients. Of those, BMM status was negative in 75.8% (210 of 277) and positive in 24.2% (67 of 277) patients. Median follow-up was 61 (range 11-96) months. Five-year disease-free survival was 93.6% (95% confidence interval [CI] 89.1-96.0) in BMM-negative and 92.2% (95% CI 82.5-96.2) in BMM-positive patients (p = 0.50). Five-year overall survival was 92.7% (95% CI 87.9-95.8) for the BMM-negative and 92.5% (95% CI 83.4-96.2) for the BMM-positive group (p = 0.85).
This is one of the first prospective studies to examine 5-year disease-free and overall survivals in SLN-negative patients in correlation to their BMM status. Although BMM are identified in one of four SLN-negative patients, they do not impact disease-free and overall survival.
淋巴结转移的存在是早期乳腺癌最重要的预后因素。骨髓微转移（BMM）是否会影响前哨淋巴结（SLN）阴性乳腺癌患者的预后仍存在争议。因此，本研究旨在评估 BMM 对这些患者 5 年无病和总生存率的影响。
我们分析了 2000 年 1 月至 2003 年 12 月期间前瞻性纳入瑞士多中心乳腺癌前哨淋巴结研究的 410 例早期乳腺癌患者（pT1 和 pT2 ≤ 3cm，cN0）。所有患者均接受骨髓抽吸术和 SLN 活检。所有 SLN 均用苏木精和伊红以及免疫组织化学（Lu-5、CK-22）染色。用针对 CK-8、-18 和 -19 的单克隆抗体 A45-B/B3 染色后，识别骨髓中的癌细胞。
410 例入组患者中，67.6%（277 例）的 SLN 为阴性。其中，BMM 状态阴性的患者占 75.8%（210 例），阳性的患者占 24.2%（67 例）。中位随访时间为 61 个月（范围 11-96 个月）。BMM 阴性患者的 5 年无病生存率为 93.6%（95%置信区间 [CI] 89.1-96.0），BMM 阳性患者为 92.2%（95% CI 82.5-96.2）（p=0.50）。BMM 阴性患者的 5 年总生存率为 92.7%（95% CI 87.9-95.8），BMM 阳性患者为 92.5%（95% CI 83.4-96.2）（p=0.85）。
这是第一项前瞻性研究之一，旨在检查与 BMM 状态相关的 SLN 阴性患者的 5 年无病和总生存率。尽管在四分之一的 SLN 阴性患者中发现了 BMM，但它们并未影响无病和总生存率。
