Ryu Jai Min, Lee Hyouk Jin, Yoon Tae In, Lee Eun Sook, Lee Soo Jung, Jung Jin Hyang, Chae Byung Joo, Nam Seok Jin, Lee Jeong Eon, Lee Se Kyung, Bae Soo Youn, Yu Jonghan, Kim Seok Won
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center Hospital, Sungkyunkwan University School of Medicine, 5th Floor Breast-Endocrine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Surgery, Saegyaero Hospital, Busan, South Korea.
Breast Cancer Res Treat. 2016 Oct;159(3):489-98. doi: 10.1007/s10549-016-3943-4. Epub 2016 Sep 2.
Tumor size and number of lymph node (LN) metastases are well known as the most important prognostic factors of breast cancer. We hypothesized that very small breast cancers with LN metastasis represent a progressive biologic behavior and evaluated tumor size stratified by LN metastasis. Data between 1990 and 2010 were obtained retrospectively from the Korean Breast Cancer Society Registry with inclusion criteria of female, non-metastatic, unilateral, and T1/2 breast cancer. We collected the following variables: age at surgery, tumor size, number of LN metastases, nuclear grade (NG), lymphovascular invasion (LVI), estrogen receptor status, progesterone receptor status, and epidermal growth factor receptor-2 status. Patient characteristics were compared by means of independent t-tests for continuous variables and the Chi-square or Fisher's exact test for categorical variables. Kaplan-Meier curves, with corresponding results of log-rank tests, were constructed for breast cancer-specific survival (BCSS). Five- and eight-year breast cancer-specific mortality (BCSM) was obtained in groups of 300 patients, followed by smoothing according to the confidence interval using the lowess method. We identified 39,826 breast cancer patients who met the inclusion criteria. Among them, 1433 (3.6 %) patients died due to breast cancer. The median follow-up duration was 63.4 (3-255) months. In the multivariate analysis, age at surgery, NG, LVI, subtype, and tumor size-nodal interactions were independently associated with BCSM. The N1 group had lower BCSS for T1a than T1b. The N2+ group also had lower BCSS for T1b than T1c or T2. In the N1 group of tumors smaller than 10 mm, 5- and 8-year BCSM decreased with larger tumor size. Patients with very small tumors with LN metastasis have decreased BCSM according to increase tumor size. Small tumors with LN metastasis could have aggressive biological behavior.
肿瘤大小和淋巴结转移数目是众所周知的乳腺癌最重要的预后因素。我们假设伴有淋巴结转移的极小乳腺癌代表一种进展性生物学行为，并按淋巴结转移情况对肿瘤大小进行分层评估。回顾性收集了1990年至2010年间韩国乳腺癌协会登记处的数据，纳入标准为女性、非转移性、单侧及T1/2期乳腺癌。我们收集了以下变量：手术年龄、肿瘤大小、淋巴结转移数目、核分级（NG）、脉管侵犯（LVI）、雌激素受体状态、孕激素受体状态及表皮生长因子受体-2状态。连续变量采用独立t检验，分类变量采用卡方检验或Fisher精确检验比较患者特征。构建了Kaplan-Meier曲线及相应的对数秩检验结果以评估乳腺癌特异性生存（BCSS）。在300例患者组中获取5年和8年乳腺癌特异性死亡率（BCSM），随后采用局部加权散点平滑法（lowess法）根据置信区间进行平滑处理。我们确定了39826例符合纳入标准的乳腺癌患者。其中，1433例（3.6%）患者死于乳腺癌。中位随访时间为63.4（3 - 255）个月。多因素分析显示，手术年龄、NG、LVI、亚型及肿瘤大小与淋巴结转移的相互作用与BCSM独立相关。N1组中T1a期患者的BCSS低于T1b期。N2+组中T1b期患者的BCSS也低于T1c期或T2期。在肿瘤小于10mm的N1组中，5年和8年BCSM随肿瘤大小增大而降低。伴有淋巴结转移的极小肿瘤患者，其BCSM随肿瘤大小增加而降低。伴有淋巴结转移的小肿瘤可能具有侵袭性生物学行为。
