阳性淋巴结数量及淋巴结比率对淋巴结阳性乳腺癌女性患者生存的影响
Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer.
作者信息
Tonellotto Fabiana, Bergmann Anke, de Souza Abrahão Karen, de Aguiar Suzana Sales, Bello Marcelo Adeodato, Thuler Luiz Claudio Santos
机构信息
Department of Surgical Oncology, Mastology Service, Hospital do Câncer III, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brasil.
Department of Clinical Research, Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brasil.
出版信息
Eur J Breast Health. 2019 Apr 1;15(2):76-84. doi: 10.5152/ejbh.2019.4414. eCollection 2019 Apr.
OBJECTIVE
This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with the risk of breast cancer recurrence and death.
MATERIALS AND METHODS
A retrospective cohort study of node-positive stage II and III breast cancer patients diagnosed and treated between 2008 and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN) and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed using stepwise forward Cox regression models.
RESULTS
In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥IIB). The median follow-up was 58 months (range: 3-92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% Confidence Interval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p<0.001), while the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p<0.001). On the other hand, the hazard of death of pN2 and pN3 patients was 2.17 (1.42-3.30) and 2.41 (1.53-3.78), respectively (p<0.001), and the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR patients was 1.70 (1.13-2.56) and 2.74 (1.75-4.28), respectively (p≤0.001).
CONCLUSION
Higher pN and LNR were associated with shorter disease-free survival and overall survival times.
目的
本研究旨在评估腋窝淋巴结比率（LNR）及阳性淋巴结数量（pN）与乳腺癌复发及死亡风险之间的关联。
材料与方法
对2008年至2009年期间在巴西国家癌症研究所（INCA）诊断并接受治疗的II期和III期淋巴结阳性乳腺癌患者进行一项回顾性队列研究。采用Kaplan-Meier法构建阳性淋巴结数量（pN）及淋巴结比率（LNR）风险组的总生存曲线和无病生存曲线，并通过对数秩检验进行比较。使用逐步向前Cox回归模型进行多变量分析。
结果
总共纳入了628例淋巴结阳性乳腺癌女性患者。大多数患者（69.5%）患有晚期临床分期肿瘤（≥IIB）。中位随访时间为58个月（范围：3 - 92个月）。与pN1患者相比，pN2和pN3患者的校正复发风险分别为2.47（95%置信区间[CI] 1.72 - 3.56）和2.42（1.62 - 3.60）（p<0.001），而与低风险LNR（≤0.20）患者相比，中度（0.21 - 0.65）和高风险（>0.65）LNR患者的风险分别为2.11（1.49 - 3.00）和3.19（2.12 - 4.80）（p<0.001）。另一方面，pN2和pN3患者的死亡风险分别为2.17（1.42 - 3.30）和2.41（1.53 - 3.78）（p<0.001），中度（0.21 - 0.65）和高风险（>0.65）LNR患者的风险分别为1.70（1.13 - 2.56）和2.74（1.75 - 4.28）（p≤0.001）。
结论
较高的pN和LNR与较短的无病生存期和总生存期相关。
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