From the Department of Pathology, The George Washington University, Washington, DC (Dr Schwartz); the Division of Cancer Control and Epidemiology, The George Washington University Medical Center Cancer Institute, Washington, DC (Dr Henson and Ms Rajamarthandan); and the Division of Epidemiology and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Chen).
Arch Pathol Lab Med. 2014 Aug;138(8):1048-52. doi: 10.5858/arpa.2013-0435-OA.
The appropriate staging of breast cancers includes an evaluation of tumor size and nodal status. Histologic grade in breast cancer, though important and assessed for all tumors, is not integrated within tumor staging.
To determine whether the histologic grade remains a prognostic factor for breast cancer regardless of tumor size and the number of involved axillary lymph nodes.
By using a new clustering algorithm, the 10-year survival for every combination of T, N, and the histologic grade was determined for cases of breast cancer obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. There were 36 combinations of TN, defined according to the American Joint Committee on Cancer, and grade.
For each combination of T and N, a categorical increase in the histologic grade was associated with a progressive decrease in 10-year survival regardless of the number of involved axillary lymph nodes or size of the primary tumor. Absolute survival differences between high and low grade persisted despite larger tumor sizes and greater nodal involvement, though trends were apparent with increasing breast cancer stage. Statistical significance depended on the number of cases for each combination.
Histologic grade continues to be of prognostic importance for overall survival despite tumor size and nodal status. Furthermore, these results seem to indicate that the assignment of the histologic grade has been consistent among pathologists when evaluated in a large data set of patients with breast cancer. The incorporation of histologic grade in TNM staging for breast cancer provides important prognostic information.
乳腺癌的适当分期包括评估肿瘤大小和淋巴结状态。虽然组织学分级在乳腺癌中很重要，并对所有肿瘤进行评估，但它并未纳入肿瘤分期。
确定组织学分级是否仍然是乳腺癌的预后因素，而与肿瘤大小和受累腋窝淋巴结的数量无关。
通过使用新的聚类算法，根据美国癌症联合委员会（American Joint Committee on Cancer）定义的 TN 以及分级，确定来自美国国家癌症研究所（National Cancer Institute）监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results）计划的乳腺癌病例的每一种 TN 和分级组合的 10 年生存率。共有 36 种 TN 组合和分级。
对于 T 和 N 的每一种组合，组织学分级的分类增加与 10 年生存率的逐渐下降相关，而与受累腋窝淋巴结的数量或原发性肿瘤的大小无关。尽管肿瘤较大且淋巴结受累较多，但高低分级之间的绝对生存差异仍然存在，尽管随着乳腺癌分期的增加，趋势明显。统计显著性取决于每种组合的病例数量。
尽管肿瘤大小和淋巴结状态，组织学分级仍然对总生存率具有重要的预后意义。此外，这些结果似乎表明，在乳腺癌患者的大型数据集评估中，病理学家在评估组织学分级时的分配具有一致性。组织学分级在 TNM 分期中的纳入为乳腺癌提供了重要的预后信息。
