Tang Chuangang, Wang Pei, Li Xiaoxin, Zhao Bingqing, Yang Haochang, Yu Haifeng, Li Changwen
Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China.
Department of Pathology, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China.
PLoS One. 2017 Aug 14;12(8):e0182953. doi: 10.1371/journal.pone.0182953. eCollection 2017.
The objective of this retrospective study was to determine whether lymph node metastasis has a prognostic impact on patients with stage IV breast cancer.
Seven thousand three hundred and seventy-nine patients with de novo stage IV breast cancer diagnosed from 2004 to 2013 were identified. Kaplan-Meier estimate method was fitted to measure overall survival and breast cancer-specific survival (BCSS). Cox proportional hazard analysis was used to evaluate the association between N stage and BCSS after controlling variables such as other patient/tumor characteristics.
The primary site of M1 tumors was mainly upper-outer quadrant and overlapping lesion of the breast. Patients with N1 disease had better overall survival and BCSS than did those without lymph node metastasis. The overall survival and BCSS of M1 patients with N3 disease were significantly lower than that of those with N0, N1 and N2 disease, whereas patients with N2 and N0/N1 involvement showed no significant difference with survival. Multivariate analysis showed that lymph node metastasis was an important prognostic factor for M1 patients (N1 versus N0, hazard ratio [HR] = 0.902, 95% confidence interval [CI]: 0.825-0.986, p = 0.023; N3 versus N0, HR = 1.161, 95% CI: 1.055-1.276, p = 0.002). For M1 patients, age, race, marital status, primary site, ER, PR and HER2 were the independent prognostic factors.
The cohort study provides an insight into de novo stage IV breast cancer with lymph node metastasis. Our results indicated that accurate lymph node evaluation for stage IV patients is still necessary to obtain important prognostic information.
本回顾性研究的目的是确定淋巴结转移对IV期乳腺癌患者的预后是否有影响。
确定了2004年至2013年诊断的7379例初诊IV期乳腺癌患者。采用Kaplan-Meier估计法测量总生存期和乳腺癌特异性生存期（BCSS）。在控制其他患者/肿瘤特征等变量后，使用Cox比例风险分析评估N分期与BCSS之间的关联。
M1肿瘤的主要部位主要是乳腺的外上象限和重叠病变。N1期疾病患者的总生存期和BCSS优于无淋巴结转移的患者。N3期M1患者的总生存期和BCSS显著低于N0、N1和N2期患者，而N2期和N0/N1期受累患者的生存期无显著差异。多因素分析显示，淋巴结转移是M1患者的重要预后因素（N1与N0相比，风险比[HR]=0.902，95%置信区间[CI]：0.825-0.986，p=0.023；N3与N0相比，HR=1.161，95%CI：1.055-1.276，p=0.002）。对于M1患者，年龄、种族、婚姻状况、原发部位、ER、PR和HER2是独立的预后因素。
队列研究为初诊IV期伴有淋巴结转移的乳腺癌提供了见解。我们的结果表明，对IV期患者进行准确的淋巴结评估对于获得重要的预后信息仍然是必要的。
