长期乳腺癌生存与腋窝淋巴结转移瘤负担的关系。

Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes.

机构信息

Department of Surgery, Västmanland County Hospital, 72189, Västerås, Sweden.

Center for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.

出版信息

Breast Cancer Res Treat. 2018 Sep;171(2):359-369. doi: 10.1007/s10549-018-4820-0. Epub 2018 May 30.

DOI:10.1007/s10549-018-4820-0

PMID:29846847

Abstract

PURPOSE

The clinical significance of lymph node micrometastases and isolated tumor cells (ITCs) in breast cancer is still controversial. After a median follow-up of 52 months, a report from the Swedish Multicenter Cohort Study presented a worse cancer-specific and event-free survival for patients with micrometastases than node-negative individuals, but could not demonstrate a significant difference in overall survival (OS). Due to the tendency of breast cancer to relapse after more than 5-10 years, we now report the long-term survival of the cohort.

METHODS

Between September 2000 and January 2004, 3355 breast cancer patients were included in a prospective cohort. Sentinel lymph node biopsy was always performed. Patients were classified in four groups according to their overall nodal stage: node negative (N0, 2372), ITCs (113), micrometastases (123), and macrometastases (747). Kaplan-Meier survival estimates and Cox proportional hazard regression models were applied.

RESULTS

Median follow-up was 156 months. Ten-year cancer-specific survival and OS were significantly lower in case of micrometastases than in N0 (84.7 vs. 93.5%, p = 0.001, and 75.5 vs. 84.2%, p = 0.046, respectively). In case of macrometastases, corresponding survival rates were 82.8 and 74.3%. Only for those aged less than 50 years, cancer-specific survival and OS were significantly worse in case of ITCs than N0. Patients with micrometastases received less often chemotherapy than those with macrometastases (24.4 vs. 53.9%).

CONCLUSIONS

Lymph node micrometastases in breast cancer have a prognostic significance. This study demonstrates a similar survival for patients with micrometastases and those with macrometastases, possibly due to systemic undertreatment.

摘要

目的

乳腺癌淋巴结微转移和孤立肿瘤细胞（ITC）的临床意义仍存在争议。在中位随访 52 个月后，瑞典多中心队列研究的一份报告显示，微转移患者的癌症特异性和无事件生存率比淋巴结阴性患者差，但总生存率（OS）无显著差异。由于乳腺癌有超过 5-10 年后复发的倾向，我们现在报告该队列的长期生存情况。

方法

在 2000 年 9 月至 2004 年 1 月期间，纳入了 3355 名乳腺癌患者进行前瞻性队列研究。始终进行前哨淋巴结活检。根据患者的总体淋巴结分期，将其分为四组：淋巴结阴性（N0，2372 例）、ITC（113 例）、微转移（123 例）和宏转移（747 例）。应用 Kaplan-Meier 生存估计和 Cox 比例风险回归模型。

结果

中位随访时间为 156 个月。与 N0 相比，微转移患者的 10 年癌症特异性生存率和 OS 显著降低（84.7%对 93.5%，p=0.001；75.5%对 84.2%，p=0.046）。宏转移患者的相应生存率为 82.8%和 74.3%。仅对于年龄小于 50 岁的患者，ITC 患者的癌症特异性生存率和 OS 明显低于 N0 患者。微转移患者接受化疗的频率明显低于宏转移患者（24.4%对 53.9%）。