Clark G M, Dressler L G, Owens M A, Pounds G, Oldaker T, McGuire W L
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7884.
N Engl J Med. 1989 Mar 9;320(10):627-33. doi: 10.1056/NEJM198903093201003.
More accurate prediction of the prognosis in women with node-negative breast cancer may improve physicians' ability to identify the patients most likely to benefit from systematic adjuvant therapy. With this in mind, we performed DNA flow-cytometric measurements of ploidy and the fraction of cells in the synthesis phase of the cell cycle (S-phase fraction) on 395 specimens of node-negative breast cancer from our bank of frozen tumors, using the aliquots of pulverized frozen tissue from steroid-receptor assays. The median duration of follow-up in patients still alive at the time of analysis was 59 months. Thirty-two percent of the 345 specimens that could be evaluated were diploid, and 68 percent were aneuploid. The probability of disease-free survival at five years was 88 +/- 3 percent in patients with diploid tumors and 74 +/- 3 percent in those with aneuploid tumors (P = 0.02). The S-phase fraction was not a significant additional predictor of disease-free survival in patients with aneuploid tumors. However, the probability of disease-free survival in patients with diploid tumors and low S-phase fractions was 90 +/- 3 percent at five years, as compared with 70 +/- 13 percent in those with diploid tumors and high S-phase fractions (P = 0.007). Similar differences in overall survival were noted. We conclude that DNA flow-cytometric measurements of ploidy and S-phase fraction can be performed on frozen specimens of tumors and are potentially important predictors of disease-free and overall survival in patients with node-negative breast cancer.
更准确地预测淋巴结阴性乳腺癌女性的预后，可能会提高医生识别最有可能从系统性辅助治疗中获益的患者的能力。考虑到这一点，我们利用来自类固醇受体检测的冷冻肿瘤组织研磨后的等分试样，对我们冷冻肿瘤库中的395例淋巴结阴性乳腺癌标本进行了DNA流式细胞术测量，以检测倍性和细胞周期合成期细胞分数（S期分数）。在分析时仍存活的患者中，随访的中位时长为59个月。在可评估的345例标本中，32%为二倍体，68%为非整倍体。二倍体肿瘤患者五年无病生存的概率为88±3%，非整倍体肿瘤患者为74±3%（P = 0.02）。S期分数并非非整倍体肿瘤患者无病生存的显著额外预测指标。然而，二倍体肿瘤且S期分数低的患者五年无病生存概率为90±3%，相比之下，二倍体肿瘤且S期分数高的患者为70±13%（P = 0.007）。总生存方面也观察到了类似差异。我们得出结论，DNA流式细胞术对倍性和S期分数的测量可在肿瘤冷冻标本上进行，并且可能是淋巴结阴性乳腺癌患者无病生存和总生存的重要预测指标。
