Sugiyama Michiko, Hasebe Takahiro, Shimada Hiroko, Takeuchi Hideki, Shimizu Kyoko, Shimizu Michio, Yasuda Masanori, Ueda Shigeto, Shigekawa Takashi, Osaki Akihiko, Saeki Toshiaki
Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan; Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
Department of Pathology, Saitama Medical University International Medical Center, Hidaka City, Saitama 350-1298, Japan.
Hum Pathol. 2015 Jun;46(6):906-16. doi: 10.1016/j.humpath.2015.03.001. Epub 2015 Mar 18.
We previously reported that the number of mitotic and apoptotic figures in tumor cells in blood vessel tumor emboli had the greatest significant power for the accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast. The purpose of the present study was to devise a grading system for blood vessel tumor emboli based on the mitotic and apoptotic figures of tumor cells in blood vessel tumor emboli, enabling accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast. We classified 263 invasive ductal carcinomas into the following 3 grades according to the numbers of mitotic and apoptotic figures in tumor cells located in blood vessels within 1 high-power field: grade 0, no blood vessel invasion; grade 1, absence of mitotic figures and presence of any number of apoptotic figures, or 1 mitotic figure and 0 to 2 apoptotic figures; and grade 2, 1 mitotic figure and 3 or more apoptotic figures, or 2 or more mitotic figures and 1 or more apoptotic figures. Multivariate analyses with well-known prognostic factors demonstrated that grade 2 blood vessel tumor emboli significantly increased the hazard ratios for tumor recurrence independent of the nodal status, pathological TNM stage, hormone receptor status, or HER2 status. The presently reported grading system for blood vessel tumor emboli is the strongest histologic factor for accurate prediction of the outcome of patients with invasive ductal carcinoma of the breast.
我们之前报道过，血管肿瘤栓子中肿瘤细胞的有丝分裂和凋亡数量对于准确预测乳腺浸润性导管癌患者的预后具有最大的显著作用。本研究的目的是基于血管肿瘤栓子中肿瘤细胞的有丝分裂和凋亡数量设计一种血管肿瘤栓子分级系统，从而能够准确预测乳腺浸润性导管癌患者的预后。我们根据1个高倍视野内血管中肿瘤细胞的有丝分裂和凋亡数量，将263例浸润性导管癌分为以下3级：0级，无血管侵犯；1级，无有丝分裂象且有任意数量的凋亡象，或1个有丝分裂象且0至2个凋亡象；2级，1个有丝分裂象且3个或更多凋亡象，或2个或更多有丝分裂象且1个或更多凋亡象。对已知预后因素进行多变量分析表明，2级血管肿瘤栓子显著增加了肿瘤复发的风险比，且与淋巴结状态、病理TNM分期、激素受体状态或HER2状态无关。目前报道的血管肿瘤栓子分级系统是准确预测乳腺浸润性导管癌患者预后的最强组织学因素。
