Min Seung Ki, Lee Se Kyung, Woo Jinsun, Jung Sung Mi, Ryu Jai Min, Yu Jonghan, Lee Jeong Eon, Kim Seok Won, Chae Byung Joo, Nam Seok Jin
Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Breast Cancer. 2021 Feb;24(1):75-84. doi: 10.4048/jbc.2021.24.e4.
Tumor size and lymph node metastasis are important factors that contribute to the progression of breast cancer. We aimed to analyze the relationship between tumor size and lymph node metastasis molecular subtype and examine the effects of nodal metastasis on overall survival (OS).
We retrospectively reviewed the data of 16,552 patients who underwent breast surgery in Samsung Medical Center between 2000 and 2015. Information on tumor size (largest diameter of the invasive component), number of positive lymph nodes, and molecular subtype were obtained. We constructed a linear regression model to evaluate the relationship between tumor size and lymph node metastasis. To determine the effect of nodal metastasis on OS, we performed a Cox proportional regression analysis with Np/T (number of metastatic lymph nodes [n]/tumor size [cm]).
This study included 12,007 patients with a median follow-up of 62 months. The linear regression coefficients were 1.043 for luminal A, 1.024 for luminal B, 0.656 for HER2, and 0.435 for triple-negative breast cancer (TNBC) subtypes. No significant difference was observed in the coefficients between the luminal A and B subtypes ( =0.797), while all other coefficients showed significant difference. After adjusting for other risk factors, the hazard ratio (HR) of Np/T for each subtype was significant for OS: luminal A (HR, 1.134; 95% confidence interval [CI], 1.097-1.171; < 0.001), luminal B (HR, 1.049; 95% CI, 1.013-1.086; =0.007), HER2 (HR, 1.069; 95% CI, 1.014-1.126; =0.013), and TNBC (HR, 1.038; 95% CI, 1.01-1.067; =0.008).
The incidence of lymph node metastasis differed according to molecular subtype. Luminal types have higher incidence of nodal metastasis than HER2 and TNBC. The HR of Np/T was highest in luminal A subtypes and lowest in TNBC subtypes.
肿瘤大小和淋巴结转移是影响乳腺癌进展的重要因素。我们旨在分析肿瘤大小与淋巴结转移分子亚型之间的关系，并研究淋巴结转移对总生存期（OS）的影响。
我们回顾性分析了2000年至2015年间在三星医疗中心接受乳腺手术的16552例患者的数据。获取了肿瘤大小（浸润成分的最大直径）、阳性淋巴结数量和分子亚型的信息。我们构建了线性回归模型来评估肿瘤大小与淋巴结转移之间的关系。为了确定淋巴结转移对OS的影响，我们使用Np/T（转移淋巴结数量[n]/肿瘤大小[cm]）进行了Cox比例回归分析。
本研究纳入了12007例患者，中位随访时间为62个月。管腔A型的线性回归系数为1.043，管腔B型为1.024，HER2型为0.656，三阴性乳腺癌（TNBC）亚型为0.435。管腔A型和B型之间的系数无显著差异（=0.797），而其他所有系数均显示出显著差异。在调整其他危险因素后，各亚型的Np/T风险比（HR）对OS均有显著意义：管腔A型（HR，1.134；95%置信区间[CI]，1.097-1.171；<0.001），管腔B型（HR，1.049；95%CI，1.013-1.086；=0.007），HER2型（HR，1.069；95%CI，1.014-1.126；=0.013），TNBC型（HR，1.038；95%CI，1.01-1.067；=0.008）。
淋巴结转移的发生率因分子亚型而异。管腔型的淋巴结转移发生率高于HER2型和TNBC型。Np/T的HR在管腔A型亚型中最高，在TNBC亚型中最低。
