He Xiaofang, Ye Feng, Li Mei, Yu Ping, Xiao Xiangsheng, Tang Hailin, Xie Xiaoming
Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Cancer Med. 2017 Nov;6(11):2489-2496. doi: 10.1002/cam4.1175. Epub 2017 Oct 4.
Multiple invasive foci has been shown to increase the risk of lymph node metastasis (LNM) in early breast cancer, but its prognostic implication remains unknown. We aimed to identify the prognostic value of the number of invasive foci in ductal carcinoma in situ with minimal invasion of the breast (DCIS-MI), and further establish a prognostic invasive lesion index (ILI). A total of 193 patients with DCIS-MI (the invasive component was up to 10 mm in diameter) were included. Univariate and multivariate analysis (logistic regression) were used to evaluate the predictive value of the number of invasive foci in LNM. The Kaplan-Meier curve was used for survival analysis. More than five invasive foci was an independent predictor for LNM (OR, 2.67, 95% CI, 1.12-6.33, P = 0.026), and associated with significantly shorter disease-free survival (DFS) and overall survival (OS) compared with no more than five invasive foci (mean DFS 123.8 vs. 148.0 months, P = 0.002; and mean OS 133.5 vs. 151.4 months, P = 0.025). The ILI was established by the sum scores of the number of invasive foci and the invasive component size, having an optimal cut-off point of 5.5 scores. The high-ILI group (ILI >5 scores) had a higher incidence of LNM (23.6% vs. 6.9%) and worse prognosis than the low-ILI group (ILI ≤5 scores). In conclusion, more than five invasive foci was an independent predictor for LNM and an unfavorable prognostic parameter. The ILI could potentially be used to predict survival prognosis in patients with DCIS-MI.
多个浸润灶已被证明会增加早期乳腺癌发生淋巴结转移（LNM）的风险，但其预后意义仍不明确。我们旨在确定乳腺微浸润导管原位癌（DCIS-MI）中浸润灶数量的预后价值，并进一步建立一个预后浸润性病变指数（ILI）。共纳入193例DCIS-MI患者（浸润成分直径最大为10毫米）。采用单因素和多因素分析（逻辑回归）来评估浸润灶数量对LNM的预测价值。采用Kaplan-Meier曲线进行生存分析。超过5个浸润灶是LNM的独立预测因素（OR为2.67，95%CI为1.12 - 6.33，P = 0.026），与不超过5个浸润灶相比，其无病生存期（DFS）和总生存期（OS）显著缩短（平均DFS为123.8个月对148.0个月，P = 0.002；平均OS为133.5个月对151.4个月，P = 0.025）。ILI通过浸润灶数量和浸润成分大小的得分总和来确定，最佳截断点为5.5分。高ILI组（ILI>5分）的LNM发生率更高（23.6%对6.9%），且预后比低ILI组（ILI≤5分）更差。总之，超过5个浸润灶是LNM的独立预测因素和不良预后参数。ILI可能可用于预测DCIS-MI患者的生存预后。
