新辅助化疗后局部晚期乳腺癌中使用淋巴结比率评估残余淋巴结负荷的预后意义
Prognostic significance of residual nodal burden using lymph node ratio in locally advanced breast cancer after neoadjuvant chemotherapy.
作者信息
Agarwal Reshu, Philip Arun, Pavithran Keechilat, Rajanbabu Anupama, Goel Gaurav, Vijaykumar D K
机构信息
Department of Breast and Gynecology Oncology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeedham, Kerala, India.
Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeedham, Kerala, India.
出版信息
Indian J Cancer. 2019 Jul-Sep;56(3):228-235. doi: 10.4103/ijc.IJC_652_18.
OBJECTIVE
To investigate the prognostic value of lymph node ratio (LNR) after neoadjuvant chemotherapy (NAC) according to breast cancer molecular subtypes.
METHODS
From 2004 to 2014, patients with definitive surgery after NAC were identified. LNR was calculated for node positive patients who underwent axillary dissection and at least 10 nodes (LNT) were removed. Disease free and overall survivals were analysed using Kaplan-Meier test and compared using log rank test for ypN0-3, LNR categories (LNRC) ≤0.2 (low), 0.21-0.65 (intermediate), >0.65 (high), and single LNR cut-off value.
RESULTS
Of 224 analysed patients: ypN0 72 (32.1%), ypN+ 152 (67.9%). Of 118 LNT ≥10 ypN+ patients LNRC: Low risk 48 (40.7%), intermediate risk 36 (30.5%), high risk 34 (28.8%). Factors significantly different in LNR categories were ypN (P < 0.001); extranodal extension (P < 0.001); present status of patients (P < 0.001); and disease status (P = 0.029). LNRC was inversely associated with 5-year DFS: Low 52.3%, intermediate 40%, and high 12.2% (log rank P < 0.001); and OS: Low 64.4%, intermediate 58.3%, and high 13.6% (log rank P < 0.001). Significant association of LNRC and DFS and OS were demonstrated in TNBC (P < 0.001) and HER2 subtypes (P = 0.045 and 0.005 respectively). A single value of LNR = 0.25 in node positive was found significant for DFS and OS in TNBC (P < 0.001) and Her2+ (P = 0.013 and P = 0.001 respectively) but not for HR+ (DFS: P = 0.132; OS: P = 0.144).
CONCLUSION
Residual nodal disease after NAC analysed by LNRC or LNR = 0.25 cut-off value, is prognostic and can discriminate between favourable and unfavourable outcomes for TNBC and Her2+ breast cancers.
目的
根据乳腺癌分子亚型探讨新辅助化疗（NAC）后淋巴结比率（LNR）的预后价值。
方法
确定2004年至2014年间接受NAC后进行确定性手术的患者。计算接受腋窝清扫且切除至少10枚淋巴结（LNT）的淋巴结阳性患者的LNR。使用Kaplan-Meier检验分析无病生存期和总生存期，并使用对数秩检验比较ypN0-3、LNR类别（LNRC）≤0.2（低）、0.21-0.65（中）、>0.65（高）以及单一LNR临界值。
结果
在224例分析患者中：ypN0 72例（32.1%），ypN+ 152例（67.9%）。在118例LNT≥10的ypN+患者中，LNRC：低风险48例（40.7%），中风险36例（30.5%），高风险34例（28.8%）。LNR类别中显著不同的因素有ypN（P<0.001）；结外扩展（P<0.001）；患者现状（P<0.001）；以及疾病状态（P = 0.029）。LNRC与5年无病生存期呈负相关：低风险52.3%，中风险40%，高风险12.2%（对数秩P<0.001）；与总生存期呈负相关：低风险64.4%，中风险58.3%，高风险13.6%（对数秩P<0.001）。在三阴性乳腺癌（TNBC）（P<0.001）和人表皮生长因子受体2（HER2）亚型（分别为P = 0.045和P = 0.005）中，LNRC与无病生存期和总生存期存在显著关联。发现淋巴结阳性患者中LNR = 0.25这一单一值对TNBC的无病生存期和总生存期具有显著意义（P<0.001），对HER2阳性患者也具有显著意义（分别为P = 0.013和P = 0.001），但对激素受体阳性（HR+）患者无显著意义（无病生存期：P = 0.132；总生存期：P = 0.144）。
结论
通过LNRC或LNR = 0.25临界值分析NAC后的残留淋巴结疾病具有预后价值，并且可以区分TNBC和HER2阳性乳腺癌的有利和不利结局。
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