Toikkanen S, Joensuu H, Klemi P
Department of Pathology, University of Turku, Finland.
Br J Cancer. 1989 Nov;60(5):693-700. doi: 10.1038/bjc.1989.342.
The nuclear DNA content of 351 breast carcinomas was determined by flow cytometry from paraffin-embedded tissue to assess the prognostic significance of DNA ploidy, the DNA index (DI) and the S-phase fraction (SPF). The minimum follow-up of the patients was 22 years, and they were all from a defined urban population. DNA ploidy correlated with histological type and grade, mitotic count and nuclear pleomorphism (P less than 0.0001), and also with axillary nodal status (P = 0.0005), tumour necrosis (P = 0.001), primary tumour size (P = 0.03), menopausal status (P = 0.004) and the presence of distant metastases at the time of the diagnosis (P = 0.04). Survival corrected for intercurrent deaths of the patients with a diploid tumour was better than that of the patients with a non-diploid tumour (P = 0.0001, 48% vs 28% at 25 years). SPF had prognostic significance in both axillary node positive and negative patients, but ploidy and DI only in the node negative group, and their significance was greater in post-menopausal than in premenopausal patients. Axillary nodal status, primary tumour size, histological grade and the type of tumour margin circumscription were the most important independent prognostic factors in Cox's multivariate analysis, and SPF had independent prognostic value, whereas ploidy and DI did not. It is concluded that DNA ploidy, DI and SPF have long-term prognostic significance in breast cancer.
通过流式细胞术测定了351例石蜡包埋组织的乳腺癌细胞核DNA含量，以评估DNA倍体、DNA指数（DI）和S期分数（SPF）的预后意义。患者的最短随访时间为22年，且均来自特定的城市人群。DNA倍体与组织学类型和分级、有丝分裂计数及核多形性相关（P<0.0001），也与腋窝淋巴结状态（P = 0.0005）、肿瘤坏死（P = 0.001）、原发肿瘤大小（P = 0.03）、绝经状态（P = 0.004）以及诊断时远处转移的存在情况（P = 0.04）相关。二倍体肿瘤患者经并发死亡校正后的生存率优于非二倍体肿瘤患者（P = 0.0001，25年时分别为48%和28%）。SPF在腋窝淋巴结阳性和阴性患者中均具有预后意义，但倍体和DI仅在淋巴结阴性组中有意义，且在绝经后患者中的意义大于绝经前患者。在Cox多因素分析中，腋窝淋巴结状态、原发肿瘤大小、组织学分级和肿瘤边缘界限类型是最重要的独立预后因素，SPF具有独立预后价值，而倍体和DI则没有。结论是DNA倍体、DI和SPF在乳腺癌中具有长期预后意义。
