Rosen P P, Groshen S, Saigo P E, Kinne D W, Hellman S
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
J Clin Oncol. 1989 Sep;7(9):1239-51. doi: 10.1200/JCO.1989.7.9.1239.
Prognostic factors have been examined in 644 patients with tumor-node-metastasis (TNM) stage T1 breast carcinoma treated by mastectomy and followed for a median of 18.2 years. Overall, 148 patients (23%) died of recurrent breast carcinoma. Eighteen (3%) were alive with recurrent disease and 478 (74%) were alive or died of other causes without recurrence. Unfavorable clinicopathologic features were larger tumor size (1.1 to 2.0 cm v less than or equal to 1 cm), perimenopausal menstrual status, the number of axillary lymph node metastases, poorly differentiated grade, presence of lymphatic tumor emboli (LI) in breast tissue near the primary tumor, blood vessel invasion (BVI), and an intense lymphoplasmacytic reaction around the tumor. Median survival after recurrence for the entire series was 2 years. This was not significantly influenced by tumor size, the number of axillary nodal metastases, the type of treatment for recurrence, or the interval to recurrence. The proportions surviving 5 and 10 years after recurrence were 17% and 5%, respectively. Among T1N0M0 cases, the chance of a local recurrence was 2.8% within 20 years. Median survival of T1N0M0 cases after local recurrence (4.5 years) was significantly longer than after systemic recurrence (1.5 years). A similar trend (3.7 v 2.0 years), not statistically significant, was seen in T1N1M0 patients, who had a 6.5% chance of local recurrence within 20 years. Median survival following systemic recurrence detected 10 or more years after diagnosis in T1N0M0 and in T1N1M0 patients was significantly longer than the median survival for systemic recurrences found in the first decade of follow-up. This difference did not apply following local recurrence in either T1N0M0 or T1N1M0 cases. It is evident that patients with T1 breast carcinoma can be subdivided into differing prognostic groups and this must be taken into account when considering the role of adjuvant chemotherapy for stage I disease. Systemic adjuvant treatment may prove to be beneficial for patients with unfavorable prognostic factors, while women with an especially low risk for recurrence (eg, T1N0M0 tumor 1.0 cm or less) might be spared such treatment.
对644例接受乳房切除术且中位随访时间为18.2年的肿瘤-淋巴结-转移（TNM）分期为T1期的乳腺癌患者的预后因素进行了研究。总体而言，148例患者（23%）死于复发性乳腺癌。18例（3%）有复发性疾病存活，478例（74%）存活或死于其他原因且无复发。不良的临床病理特征包括肿瘤较大（1.1至2.0 cm对比小于或等于1 cm）、围绝经期月经状态、腋窝淋巴结转移数量、低分化分级、原发肿瘤附近乳腺组织中存在淋巴管瘤栓（LI）、血管侵犯（BVI）以及肿瘤周围强烈的淋巴浆细胞反应。整个系列复发后的中位生存期为2年。这并未受到肿瘤大小、腋窝淋巴结转移数量、复发治疗类型或复发间隔的显著影响。复发后存活5年和10年的比例分别为17%和5%。在T1N0M0病例中，20年内局部复发的几率为2.8%。T1N0M0病例局部复发后的中位生存期（4.5年）显著长于全身复发后的中位生存期（1.5年）。在T1N1M0患者中也观察到类似趋势（3.7对比2.0年），虽无统计学意义，这些患者20年内局部复发的几率为6.5%。在T1N0M0和T1N1M0患者中，诊断后10年或更久检测到的全身复发后的中位生存期显著长于随访第一个十年中发现的全身复发的中位生存期。在T1N0M0或T1N1M0病例中，局部复发后不存在这种差异。显然，T1期乳腺癌患者可分为不同的预后组，在考虑I期疾病辅助化疗的作用时必须考虑到这一点。全身辅助治疗可能对具有不良预后因素的患者有益，而复发风险特别低的女性（例如，肿瘤1.0 cm或更小的T1N0M0）可能无需接受此类治疗。
