Nottegar A, Veronese N, Senthil M, Roumen R M, Stubbs B, Choi A H, Verheuvel N C, Solmi M, Pea A, Capelli P, Fassan M, Sergi G, Manzato E, Maruzzo M, Bagante F, Koç M, Eryilmaz M A, Bria E, Carbognin L, Bonetti F, Barbareschi M, Luchini C
Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy.
Department of Medicine, DIMED, University of Padua, Padua, Italy.
Eur J Surg Oncol. 2016 Jul;42(7):919-25. doi: 10.1016/j.ejso.2016.02.259. Epub 2016 Mar 10.
Invasive breast cancer is the most common malignancy in women. Its most common site of metastasis is represented by the lymph nodes of axilla, and the sentinel lymph node (SLN) is the first station of nodal metastasis. Axillary SLN biopsy accurately predicts axillary lymph node status and has been accepted as standard of care for nodal staging in breast cancer. To date, the morphologic aspects of SLN metastasis have not been considered by the oncologic staging system. Extranodal extension (ENE) of nodal metastasis, defined as extension of neoplastic cells through the nodal capsule into the peri-nodal adipose tissue, has recently emerged as an important prognostic factor in several types of malignancies. It has also been considered as a possible predictor of non-sentinel node tumor burden in SLN-positive breast cancer patients. We sought out to clarify the prognostic role of ENE in SLN-positive breast cancer patients in terms of overall and disease-free survival by conducting a systematic review and meta-analysis. Among 172 screened articles, 5 were eligible for the meta-analysis; they globally include 624 patients (163 ENE+ and 461 ENE-) with a median follow-up of 58 months. ENE was associated with a higher risk of both mortality (RR = 2.51; 95% CI: 1.66-3.79, p < 0.0001, I(2) = 0%) and recurrence of disease (RR = 2.07, 95% CI: 1.38-3.10, p < 0.0001, I(2) = 0%). These findings recommend the consideration of ENE from the gross sampling to the histopathological evaluation, in perspectives to be validated and included in the oncologic staging.
浸润性乳腺癌是女性最常见的恶性肿瘤。其最常见的转移部位是腋窝淋巴结，前哨淋巴结（SLN）是淋巴结转移的第一站。腋窝前哨淋巴结活检可准确预测腋窝淋巴结状态，已被接受为乳腺癌淋巴结分期的标准治疗方法。迄今为止，肿瘤分期系统尚未考虑前哨淋巴结转移的形态学方面。淋巴结转移的结外扩展（ENE），定义为肿瘤细胞穿过淋巴结包膜延伸至淋巴结周围脂肪组织，最近已成为几种恶性肿瘤的重要预后因素。它也被认为是前哨淋巴结阳性乳腺癌患者非前哨淋巴结肿瘤负荷的一个可能预测指标。我们通过进行系统评价和荟萃分析，试图阐明ENE在前哨淋巴结阳性乳腺癌患者的总生存和无病生存方面的预后作用。在172篇筛选的文章中，5篇符合荟萃分析的条件；它们总共纳入了624例患者（163例ENE阳性和461例ENE阴性），中位随访时间为58个月。ENE与更高的死亡风险（RR = 2.51；95%CI：1.66 - 3.79，p < 0.0001，I² = 0%）和疾病复发风险（RR = 2.07，95%CI：1.38 - 3.10，p < 0.0001，I² = 0%）相关。这些发现建议从大体标本取材到组织病理学评估都应考虑ENE，以期得到验证并纳入肿瘤分期。
