Kinoe Hiroko, Yamanouchi Kosho, Kuba Sayaka, Morita Michi, Sakimura Chika, Kanetaka Kengo, Takatsuki Mitsuhisa, Abe Kuniko, Yano Hiroshi, Matsumoto Megumi, Otsubo Ryota, Hayashida Naomi, Nagayasu Takeshi, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J BUON. 2018 Dec;23(7):60-66.
We herein report the discordance rate between primary breast cancer and synchronous axillary node metastasis, its characteristics and its prognostic impact.
One hundred and four patients with invasive breast cancer with synchronous axillary node metastasis who underwent surgery were included. Estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), and Ki-67 were stained by immunohistochemistry in both primary and node metastasis. The cut-off values of the ER/PgR and Ki-67 labeling index were set at 10% and 14%, respectively. HER2 was classified according to the ASCO/CAP guidelines.
Cases positive for ER, PgR, and HER2 were 65.4%, 51.0%, and 27.9% and those with a high Ki-67 labeling index were 47.1% in primary breast cancer, respectively, while they were 47.1%, 30.8%, 16.3%, and 75.0% in node metastasis, respectively. The discordance rates between primary and node were 28.8% for ER (positive in primary→negative in node/negative→positive 22.1%/6.7%), 31.7% for PgR (26.9%/4.8%), 13.5% for HER2 (12.5%/1.0%), and 43.3% for Ki-67 (high in primary→low in node/low→high 12.5%/30.8%). The proportions of labeled cells in primary/node were as follows: ER 42.7%/25.2%, PgR 32.1%/14.0%, Ki-67 20.3%/37.1% (p<0.01 each). Regarding the cut-off value of Ki-67 in node metastasis as defined by a receiver operating characteristic (ROC) analysis, the patients with values >33.2% tended to have a poor recurrence-free survival (RFS) (p=0.08).
The expression of hormone receptors tended to weaken while the proliferative status remained strong in axillary metastasis. A high Ki-67 labeling index in axillary lymph node metastasis may be a risk factor for recurrence.
我们在此报告原发性乳腺癌与同期腋窝淋巴结转移之间的不一致率、其特征及其对预后的影响。
纳入104例接受手术治疗的伴有同期腋窝淋巴结转移的浸润性乳腺癌患者。对原发性肿瘤和淋巴结转移灶均采用免疫组织化学方法检测雌激素受体（ER）、孕激素受体（PgR）、人表皮生长因子受体2（HER2）和Ki-67。ER/PgR和Ki-67标记指数的临界值分别设定为10%和14%。HER2根据美国临床肿瘤学会/美国病理学家协会（ASCO/CAP）指南进行分类。
原发性乳腺癌中ER、PgR和HER2阳性病例分别为65.4%、51.0%和27.9%，Ki-67标记指数高的病例为47.1%，而在淋巴结转移中分别为47.1%、30.8%、16.3%和75.0%。原发性肿瘤与淋巴结之间ER的不一致率为28.8%（原发性阳性→淋巴结阴性/原发性阴性→淋巴结阳性 22.1%/6.7%），PgR为31.7%（26.9%/4.8%），HER2为13.5%（12.5%/1.0%），Ki-67为43.3%（原发性高→淋巴结低/原发性低→淋巴结高 12.5%/30.8%）。原发性/淋巴结中标记细胞的比例如下：ER 42.7%/25.2%，PgR 32.1%/14.0%，Ki-67 20.3%/37.1%（各p<0.01）。根据受试者工作特征（ROC）分析确定的淋巴结转移中Ki-67的临界值，Ki-67值>33.2%的患者无复发生存期（RFS）往往较差（p=0.08）。
在腋窝转移中，激素受体的表达趋于减弱，而增殖状态仍然较强。腋窝淋巴结转移中高Ki-67标记指数可能是复发的危险因素。
