浸润性小叶癌腋窝淋巴结转移的预后价值

Prognostic value of axillary lymph node metastases in invasive lobular breast carcinoma.

作者信息

Deberti M, Goupille C, Arbion F, Vilde A, Body G, Ouldamer L

机构信息

Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France.

Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit 1069 Tours, France.

出版信息

J Gynecol Obstet Hum Reprod. 2023 Dec;52(10):102665. doi: 10.1016/j.jogoh.2023.102665. Epub 2023 Sep 20.

DOI:10.1016/j.jogoh.2023.102665

PMID:37734568

Abstract

BACKGROUND

Axillary lymph node involvement is a well-established prognostic factor for recurrence in breast cancer, specifically the number of nodes affected and the ratio of the number of affected nodes to the number of harvested nodes for non-specific invasive breast cancer (invasive ductal carcinoma). However, there is limited information on the impact of lymph node involvement in the case of invasive lobular carcinoma.

OBJECTIVES

our study aimed to evaluate the prognostic impact of lymph node involvement on overall survival and distant metastatic-free survival according to the number of nodes affected and the ratio of positive nodes (LNR) for patients managed for invasive lobular carcinoma.

METHODS

This is a monocentre, comparative, observational study of patients managed for invasive lobular carcinoma at the Gynaecology Department of the University Hospital Center of Tours between January 1, 2007 and December 31, 2018. The LNR cut-off values used were: low risk if LNR ≤ 0.2; intermediate risk if LNR > 0.2 and ≤ 0.65, and high risk for LNR >0.659.

RESULTS

Our study demonstrated a significant difference in overall survival and distant metastasis free survival (p < 0.0001). The 5-years Overall survival was 94 % for N0 patients, 92.4 % for low-risk patients, 85.6 % for intermediate-risk patients and 58.5 % for high-risk patients. The 5-year distant metastasis-free survival was 98.2 % for N0 patients, 95.9 % for low-risk patients, 80.1 % for intermediate-risk patients, and 60.3 % for high-risk patients. Multivariate analysis identified age, invasive lobular histologic type, presence of clinical inflammation, and intermediate and high risk classes of LNR ratio as independent factors affecting overall survival. For metastatic-free survival, the presence of clinical inflammation, the presence of LVSI and the low, intermediate, or high-risk classes of LNR ratio were identified as independent factors. However, age and invasive lobular histologic type did not appear to be independent factors affecting metastatic-free survival.

CONCLUSION

Our study highlights the significant prognostic impact of lymph node involvement in patients with invasive lobular carcinoma. The LNR ratio can be used as a reliable predictor of overall survival and metastatic-free survival in these patients.

摘要

背景

腋窝淋巴结受累是乳腺癌复发的一个公认的预后因素，特别是对于非特殊浸润性乳腺癌（浸润性导管癌），受累淋巴结的数量以及受累淋巴结数量与获取淋巴结数量的比值。然而，关于浸润性小叶癌病例中淋巴结受累的影响的信息有限。

目的

我们的研究旨在根据受累淋巴结数量和阳性淋巴结比值（LNR），评估淋巴结受累对浸润性小叶癌患者总生存期和无远处转移生存期的预后影响。

方法

这是一项在图尔大学医院中心妇科对2007年1月1日至2018年12月31日期间接受治疗的浸润性小叶癌患者进行的单中心、比较性、观察性研究。所使用的LNR临界值为：LNR≤0.2为低风险；LNR>0.2且≤0.65为中度风险；LNR>0.659为高风险。

结果

我们的研究显示总生存期和无远处转移生存期存在显著差异（p<0.0001）。N0患者的5年总生存率为94%，低风险患者为92.4%，中度风险患者为85.6%，高风险患者为58.5%。N0患者的5年无远处转移生存率为98.2%，低风险患者为95.9%，中度风险患者为80.1%，高风险患者为60.3%。多因素分析确定年龄、浸润性小叶组织学类型、临床炎症的存在以及LNR比值的中度和高度风险类别为影响总生存期的独立因素。对于无转移生存期，临床炎症的存在、淋巴管血管浸润的存在以及LNR比值的低、中、高风险类别被确定为独立因素。然而，年龄和浸润性小叶组织学类型似乎不是影响无转移生存期的独立因素。