病理N3a淋巴结分期乳腺癌患者的长期预后

Long-term outcome of breast cancer patients with pathologic N3a lymph node stage.

作者信息

Grassadonia Antonino, Vici Patrizia, Gamucci Teresa, Moscetti Luca, Pizzuti Laura, Mentuccia Lucia, Iezzi Laura, Scognamiglio Maria Teresa, Zilli Marinella, Giampietro Jamara, Graziano Vincenzo, Natoli Clara, Tinari Nicola

机构信息

Department of Medical, Oral and Biotechnological Sciences, Center of Aging Sciences and Translational Medicine (CeSI-MeT), G. D'Annunzio University, Chieti, Italy.

Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.

出版信息

Breast. 2017 Apr;32:79-86. doi: 10.1016/j.breast.2016.12.018. Epub 2017 Jan 5.

DOI:10.1016/j.breast.2016.12.018

PMID:28064072

Abstract

PURPOSE

To evaluate factors influencing the long-term outcome of patients presenting with 10 or more metastatic axillary lymph nodes (pN3a) after surgery for primary breast cancer.

METHOD

Between January 1990 and December 2015, a total of 130 patients with pN3a breast cancer at surgery were identified in our Institutions and included in the study. Twenty-nine of them (22.3%) received neoadjuvant chemotherapy. The Multivariate Cox proportional hazards model was used to determine independent prognostic factors associated with DFS and OS.

RESULTS

After a median follow-up of 6.4 years (range 0.87-25 years), 2 patients had a local relapse, 59 distant metastases (1 with local relapse) and 52 patients died. The 5-year DFS and OS rates were 61.8% and 71.5%, respectively. At multivariate analysis, pN3a stage after neoadjuvant chemotherapy (ypN3a) was significantly associated with increased risk of recurrence (HR 1.92, p = 0.02) and death (HR 2.05, p = 0.029). Absence of progesterone receptor (PR) expression was the most important tumor characteristic associated with poor prognosis, both in terms of recurrence (HR 2.55, p < 0.001) and death (HR 2.23, p = 0.019). High levels of Ki-67 index (≥20%) were significantly associated with a shorter OS (HR 2.03, p = 0.027), but not with DFS.

CONCLUSIONS

The results of this study indicate that ypN3a stage, lack of expression of PR, and Ki-67 ≥ 20% negatively affect long-term outcome of patients with pN3a breast cancer.

摘要

目的

评估影响原发性乳腺癌手术后出现10个或更多腋窝转移性淋巴结（pN3a）患者长期预后的因素。

方法

1990年1月至2015年12月期间，我们机构共确定了130例手术时患有pN3a乳腺癌的患者并纳入研究。其中29例（22.3%）接受了新辅助化疗。采用多变量Cox比例风险模型确定与无病生存期（DFS）和总生存期（OS）相关的独立预后因素。

结果

中位随访6.4年（范围0.87 - 25年）后，2例患者出现局部复发，59例发生远处转移（1例伴有局部复发），52例患者死亡。5年DFS率和OS率分别为61.8%和71.5%。多变量分析显示，新辅助化疗后的pN3a分期（ypN3a）与复发风险增加（风险比[HR] 1.92，p = 0.02）和死亡风险增加（HR 2.05，p = 0.029）显著相关。孕激素受体（PR）表达缺失是与预后不良相关的最重要肿瘤特征，无论是在复发方面（HR 2.55，p < 0.001）还是死亡方面（HR 2.23，p = 0.019）。高水平的Ki-67指数（≥20%）与较短的OS显著相关（HR 2.03，p = 0.027），但与DFS无关。