Department of Surgery, Västmanland County Hospital, 72189, Västerås, Sweden.
Center for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
Breast Cancer Res Treat. 2018 Sep;171(2):359-369. doi: 10.1007/s10549-018-4820-0. Epub 2018 May 30.
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.
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.
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%).
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.
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。
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。
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%）。
乳腺癌淋巴结微转移具有预后意义。本研究表明，微转移患者的生存与宏转移患者相似，这可能是由于系统治疗不足所致。
