Iqbal Javaid, Ginsburg Ophira, Giannakeas Vasily, Rochon Paula A, Semple John L, Narod Steven A
Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Breast Cancer Res Treat. 2017 Jan;161(1):103-115. doi: 10.1007/s10549-016-4015-5. Epub 2016 Oct 28.
The clinical significance of nodal micrometastasis is debated. Our primary objective was to determine whether, among women with early-stage breast cancer, regional lymph node micrometastasis is an independent risk factor for mortality. The secondary objective was to identify subgroups of women who have the highest risk of death from early-stage breast cancer with micrometastases.
206,625 women diagnosed with early-stage breast cancer (IA, IB, and IIA) from 2004 to 2012 were identified in the Surveillance, epidemiology, and end results database. Nodal status was classified as node-negative, isolated-tumor cells, micrometastases, and macrometastases. Women were classified into eight ethnic groups. Logistic regression was performed to estimate the odds ratio of being diagnosed with micrometastases. The Cox proportional hazard model was used to estimate the hazard ratio (HR) of breast cancer-specific death associated with micrometastases for each ethnic group.
The 8-year breast cancer-specific survival was 96.6 % for women with node-negative breast cancers and was 94.6 % for women with micrometastases (adjusted HR 1.49; 95 % CI 1.31-1.69; P < .001). Among women with micrometastases, the 8-year breast cancer-specific survival was 95.1 % for white women and was 90.6 % for black women (HR 1.80; 95 % CI 1.29-2.52; P = .0006).
CONCLUSION(S): Nodal micrometastasis is an independent risk factor for breast cancer mortality among women with early-stage breast cancer. Black women are more likely to die from breast cancer with micrometastases than white women.
淋巴结微转移的临床意义存在争议。我们的主要目标是确定在早期乳腺癌女性中，区域淋巴结微转移是否为死亡的独立危险因素。次要目标是识别早期乳腺癌伴微转移的女性中死亡风险最高的亚组。
在监测、流行病学和最终结果数据库中识别出2004年至2012年诊断为早期乳腺癌（IA期、IB期和IIA期）的206,625名女性。淋巴结状态分为淋巴结阴性、孤立肿瘤细胞、微转移和宏转移。女性被分为八个种族群体。进行逻辑回归以估计被诊断为微转移的比值比。使用Cox比例风险模型估计每个种族群体中与微转移相关的乳腺癌特异性死亡的风险比（HR）。
淋巴结阴性乳腺癌女性的8年乳腺癌特异性生存率为96.6%，微转移女性为94.6%（校正HR 1.49；95%CI 1.31 - 1.69；P <.001）。在微转移女性中，白人女性的8年乳腺癌特异性生存率为95.1%，黑人女性为90.6%（HR 1.80；95%CI 1.29 - 2.52；P =.0006）。
淋巴结微转移是早期乳腺癌女性乳腺癌死亡的独立危险因素。黑人女性比白人女性更易死于伴有微转移的乳腺癌。
