Koscielny S, Le M G, Tubiana M
Institut Gustave-Roussy, Villejuif, France.
Br J Cancer. 1989 May;59(5):775-82. doi: 10.1038/bjc.1989.162.
A method has been developed for determining the mean volume of breast cancer in women at the time of the involvement of the first, second, third,... nth axillary lymph nodes. It has been found that the proportion of patients with axillary involvement as well as the number of involved nodes increase progressively with tumour size. This orderly involvement of axillary nodes is observed in all patient subsets despite a wide spread of tumour volume at the time of invasion of the axillary nodes. This makes it possible to compute for each patient or subset of patients the size of the tumour at the time of the first node involvement, a parameter which characterises the propensity for nodal involvement. A strong correlation was demonstrated between the propensity to lymphatic involvement and the probability of distant dissemination. During tumour progression the capacity for lymphatic spread is on average acquired much earlier than the capacity for haematogenous spread. For tumours of the outer quadrants, the volume at first axillary involvement is smaller than for tumours located in the inner quadrants, whereas the tumour volumes at the time of distant metastatic initiation are equal for the two tumour sites. The discrepancy between these two observations shows that axillary involvement, while being a good index of the propensity of the tumour cells to acquire the capacity for distant spread, is not the cause of this spread. From a clinical point of view, these data show that the prognostic significance of axillary involvement can be further increased by taking into account the size of the tumour. The data suggest that there is a continuum from slow growing disease with late axillary involvement and late distant dissemination to the most aggressive subtype.
已开发出一种方法，用于确定女性乳腺癌在出现第一、第二、第三……第n个腋窝淋巴结受累时的平均体积。研究发现，腋窝受累患者的比例以及受累淋巴结的数量均随肿瘤大小的增加而逐渐上升。尽管在腋窝淋巴结受侵时肿瘤体积差异很大，但在所有患者亚组中均观察到腋窝淋巴结的这种有序受累情况。这使得能够为每位患者或患者亚组计算出首个淋巴结受累时肿瘤的大小，该参数可表征淋巴结受累的倾向。研究表明，淋巴受累倾向与远处转移概率之间存在很强的相关性。在肿瘤进展过程中，淋巴转移能力平均比血行转移能力更早获得。对于外象限的肿瘤，首次腋窝受累时的体积小于内象限肿瘤，而远处转移开始时两个肿瘤部位的肿瘤体积相等。这两个观察结果之间的差异表明，腋窝受累虽然是肿瘤细胞获得远处转移能力倾向的良好指标，但并非远处转移的原因。从临床角度来看，这些数据表明，通过考虑肿瘤大小，腋窝受累的预后意义可进一步提高。数据表明，从腋窝受累晚、远处转移晚的生长缓慢的疾病到最具侵袭性的亚型存在一个连续谱。
