Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital and University of Helsinki, P.O. Box 263, FIN-00029 HUS, Helsinki, Finland.
Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, P.O. Box 180, FIN-00029 HUS, Helsinki, Finland.
Br J Cancer. 2018 May;118(11):1529-1535. doi: 10.1038/s41416-018-0052-7. Epub 2018 Apr 24.
The prognostic significance of isolated tumour cells (ITCs) in the sentinel nodes (SNs) is controversial in early breast cancer, and some centres have abandoned immunohistochemistry to detect ITCs.
Patients with unilateral pT1N0 breast cancer, operated between February 2001 and August 2005 at a university hospital were included in this prospective, population-based cohort study. Survival of 936 patients with or without isolated tumour cells (ITC) in their SNs were compared with the log-rank test and Cox regression analysis.
Eight hundred sixty one (92.0%) patients were ITC-negative (pN0i-) and 75 (8.0%) ITC-positive (pN0i+). Patients with ITC-positive cancer received more frequently adjuvant systemic therapies than those with ITC-negative cancer. The median follow-up time was 9.5 years. Ten-year distant disease-free survival was 95.3% in the pN0i- group and 88.8% in the pN0i+ group (P = 0.013). ITCs were an independent prognostic factor in a Cox regression model (HR = 2.34, 95% CI 1.09-5.04; P = 0.029), together with tumour Ki-67 proliferation index and diameter. ITCs were associated with unfavourable overall survival (P = 0.005) and breast cancer-specific survival (P = 0.001).
We conclude that presence of ITCs in the SNs is an adverse prognostic factor in early small node-negative breast cancer, and may be considered in the decision-making for adjuvant therapy.
在早期乳腺癌中，前哨淋巴结（SNs）中孤立肿瘤细胞（ITCs）的预后意义仍存在争议，一些中心已放弃免疫组织化学检测 ITCs。
本前瞻性、基于人群的队列研究纳入了 2001 年 2 月至 2005 年 8 月在一所大学医院接受单侧 pT1N0 乳腺癌手术的患者。采用对数秩检验和 Cox 回归分析比较 SN 中存在或不存在孤立肿瘤细胞（ITC）的 936 例患者的生存情况。
861 例（92.0%）患者 SN 为阴性（pN0i-），75 例（8.0%）患者 SN 为阳性（pN0i+）。与 pN0i- 组相比，pN0i+ 组的患者更常接受辅助全身治疗。中位随访时间为 9.5 年。pN0i- 组的 10 年远处无病生存率为 95.3%，pN0i+ 组为 88.8%（P=0.013）。在 Cox 回归模型中，ITCs 是独立的预后因素（HR=2.34，95%CI 1.09-5.04；P=0.029），与肿瘤 Ki-67 增殖指数和直径共同作用。ITCs 与不良总生存（P=0.005）和乳腺癌特异性生存（P=0.001）相关。
我们的结论是，SNs 中存在 ITCs 是早期小淋巴结阴性乳腺癌的不良预后因素，可能在辅助治疗决策中被考虑。
