Liu Gang, Xing Zeyu, Guo Changyuan, Dai Qichen, Cheng Han, Wang Xiang, Tang Yu, Wang Yipeng
Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2023 Aug 4;13:1217869. doi: 10.3389/fonc.2023.1217869. eCollection 2023.
To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS).
Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model.
We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients.
In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.
分析中国T1期乳腺癌患者的临床病理危险因素及区域淋巴结转移（LNM）的规律模式，以及其对总生存期（OS）和无病生存期（DFS）的影响。
回顾1999年至2020年间符合单侧、无远处转移灶及T1期浸润性导管癌纳入标准的乳腺癌患者。从病历中提取临床病理特征。采用Kaplan-Meier法和校正后的Cox比例风险模型进行生存分析。
我们纳入了11407例符合条件的患者作为发现队列以探索LNM的危险因素，并纳入3484例T1N0期患者作为生存分析队列以确定这些危险因素对OS和DFS的影响。与N-状态患者相比，N+状态患者年龄更小、肿瘤更大、Ki67水平更高、分级更高、HR+和HER2+百分比更高，以及管腔B和HER2阳性亚型百分比更高。逻辑回归表明年龄是LNM的保护因素，而肿瘤大小/更高分级/HR+和HER2+是危险因素。与局限性LNM（N1）患者相比，广泛性LNM（N2/3）患者肿瘤更大、Ki67水平更高、分级更高、HR-和HER2+百分比更高，以及管腔A亚型百分比更低。逻辑回归表明HR+是广泛性LNM的保护因素，而肿瘤大小/更高分级/HER2+是危险因素。Kaplan-Meier分析表明分级是OS和DFS的预测因素；HR是OS的预测因素，但不是DFS的预测因素。使用Cox回归模型的多因素生存分析表明，在T1N0期患者中，年龄和Ki67水平是OS的预测因素，分级和HER2状态是DFS的预测因素。
在T1期乳腺癌患者中，N-和N+患者、局限性LNM和广泛性LNM患者之间存在若干差异。此外，HR+在区域LNM中起双重作用。在无LNM的患者中，年龄和Ki67水平是OS的预测因素，分级和HER2是DFS的预测因素。
