Bae Hyeon Woo, Yoon Kwang Hyun, Kim Joo Heung, Lim Sung Mook, Kim Jee Ye, Park Hyung Seok, Park Seho, Kim Seung Il, Cho Young Up, Park Byeong-Woo
Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea.
World J Surg. 2018 Dec;42(12):3969-3978. doi: 10.1007/s00268-018-4725-4.
This study investigated the impact of pN1mi disease on the survival of T1 breast cancer patients and examined the clinical usefulness of the online PREDICT tool and updated staging system.
The node stages of 2344 patients were divided into pN0, pN1mi, and pN1a. Clinicopathological parameters and survival outcomes were retrospectively analyzed. Data for 111 micrometastatic diseases were applied to the PREDICT version 2.0 and re-classified using the 8th edition of the cancer staging manual.
Univariable analyses demonstrated worse disease-free and overall survival rates for patients with node-positive cancer; however, the significance was not maintained in multivariable analyses. Chemotherapy improved outcomes in patients with node-positive and non-luminal A-like subtype cancers. The PREDICT tool demonstrated good performance when estimating the 5-year overall survival for pN1mi disease (area under the receiver operating characteristic curve, 0.834). According to the updated staging system, 74% of cases were down-staged to IA, and clearly splitting survival curves were identified.
pN1mi disease alone did not adversely affect survival outcomes. Biologic and treatment factors determined outcomes in cases of small-volume node micrometastasis. The PREDICT tool or new staging classification could help predict the survival of patients with micrometastatic sentinel nodes.
本研究调查了pN1mi疾病对T1期乳腺癌患者生存的影响，并检验了在线PREDICT工具和更新后的分期系统的临床实用性。
将2344例患者的淋巴结分期分为pN0、pN1mi和pN1a。对临床病理参数和生存结果进行回顾性分析。将111例微转移疾病的数据应用于PREDICT 2.0版本，并根据第8版癌症分期手册重新分类。
单因素分析显示淋巴结阳性癌症患者的无病生存率和总生存率较差；然而，在多因素分析中这种显著性未得到维持。化疗改善了淋巴结阳性和非腔面A型亚型癌症患者的预后。PREDICT工具在估计pN1mi疾病的5年总生存率时表现良好（受试者工作特征曲线下面积为0.834）。根据更新后的分期系统，74%的病例分期降为IA期，且生存曲线明显分开。
单纯pN1mi疾病对生存结果没有不利影响。生物学和治疗因素决定了小体积淋巴结微转移病例的预后。PREDICT工具或新的分期分类有助于预测微转移前哨淋巴结患者的生存情况。
