Chu Jinah, Bae Hyunsik, Seo Youjeong, Cho Soo Youn, Kim Seok-Hyung, Cho Eun Yoon
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Pathol Transl Med. 2018 Nov;52(6):396-403. doi: 10.4132/jptm.2018.10.03. Epub 2018 Oct 23.
In the current American Joint Committee on Cancer staging system of breast cancer, only tumor size determines T-category regardless of whether the tumor is single or multiple. This study evaluated if tumor multiplicity has prognostic value and can be used to subclassify breast cancer.
We included 5,758 patients with invasive breast cancer who underwent surgery at Samsung Medical Center, Seoul, Korea, from 1995 to 2012.
Patients were divided into two groups according to multiplicity (single, n = 4,744; multiple, n = 1,014). Statistically significant differences in lymph node involvement and lymphatic invasion were found between the two groups (p < .001). Patients with multiple masses tended to have luminal A molecular subtype (p < .001). On Kaplan-Meier survival analysis, patients with multiple masses had significantly poorer disease-free survival (DFS) (p = .016). The prognostic significance of multiplicity was seen in patients with anatomic staging group I and prognostic staging group IA (p = .019 and p = .032, respectively). When targeting patients with T1-2 N0 M0, hormone receptor-positive, and human epidermal growth factor receptor 2 (HER2)-negative cancer, Kaplan-Meier survival analysis also revealed significantly reduced DFS with multiple cancer (p = .031). The multivariate analysis indicated that multiplicity was independently correlated with worse DFS (hazard ratio, 1.23; 95% confidence interval, 1.03 to 1.47; p = .025). The results of this study indicate that tumor multiplicity is frequently found in luminal A subtype, is associated with frequent lymph node metastasis, and is correlated with worse DFS.
Tumor multiplicity has prognostic value and could be used to subclassify invasive breast cancer at early stages. Adjuvant chemotherapy would be necessary for multiple masses of T1-2 N0 M0, hormone-receptor-positive, and HER2-negative cancer.
在当前美国癌症联合委员会的乳腺癌分期系统中，仅肿瘤大小决定T分期，而不论肿瘤是单发还是多发。本研究评估了肿瘤的多发性是否具有预后价值，以及是否可用于对乳腺癌进行亚分类。
我们纳入了1995年至2012年在韩国首尔三星医疗中心接受手术的5758例浸润性乳腺癌患者。
根据肿瘤多发性将患者分为两组（单发，n = 4744；多发，n = 1014）。两组之间在淋巴结受累和淋巴管侵犯方面存在统计学显著差异（p <.001）。多发肿块患者倾向于具有管腔A型分子亚型（p <.001）。在Kaplan-Meier生存分析中，多发肿块患者的无病生存期（DFS）明显较差（p =.016）。多发性的预后意义在解剖分期I组和预后分期IA组患者中可见（分别为p =.019和p =.032）。当针对T1-2 N0 M0、激素受体阳性且人表皮生长因子受体2（HER2）阴性的癌症患者时，Kaplan-Meier生存分析也显示多发癌患者的DFS显著降低（p =.031）。多变量分析表明，多发性与较差的DFS独立相关（风险比，1.23；95%置信区间，1.03至1.47；p =.025）。本研究结果表明，肿瘤多发性在管腔A型亚型中常见，与频繁的淋巴结转移相关，且与较差的DFS相关。
肿瘤多发性具有预后价值，可用于对早期浸润性乳腺癌进行亚分类。对于T1-2 N0 M0、激素受体阳性且HER2阴性的多发癌，辅助化疗是必要的。
