Figueroa J A, Yee D, McGuire W L
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7884.
Am J Med Sci. 1993 Mar;305(3):176-82. doi: 10.1097/00000441-199303000-00010.
Approximately 115,000 new cases of axillary node negative breast cancer were diagnosed in this country last year. Since about 20-30% of these patients will ultimately relapse and die of their disease, adjuvant systemic therapy has been advocated for this group to decrease the relapse rate and prolong survival. However, although most clinical trials have demonstrated a modest impact on disease recurrence, the available data have failed to show consistent improvements in overall survival and does not justify the generalized use of systemic treatment in this patient subgroup. For this reason, a plethora of prognostic factors have been described to identify those patients with a higher risk of recurrence to concentrate therapeutic options in this specific group. Of all the disease prognosticators studied, tumor size, nuclear grade, and proliferative indexes appear to correlate well with tumor recurrence. In addition, biologic characteristics of primary tumors such as the presence of hormone and growth factor receptors, secretion of specific polypeptides and proteases, expression of proto-oncogenes, and abnormalities in tumor suppressor genes have been shown to be potentially useful as prognostic indicators in patients with early breast cancer. Despite these provocative data, larger clinical trials are necessary before incorporating these parameters in the routine evaluation of patients with axillary node negative breast cancer.
去年，该国约有11.5万例腋窝淋巴结阴性乳腺癌新发病例。由于这些患者中约20%-30%最终会复发并死于该疾病，因此一直提倡对这组患者进行辅助全身治疗，以降低复发率并延长生存期。然而，尽管大多数临床试验已证明对疾病复发有一定影响，但现有数据未能显示总体生存期有持续改善，且并不支持在该患者亚组中普遍使用全身治疗。因此，人们描述了大量预后因素，以识别那些复发风险较高的患者，从而将治疗选择集中在这一特定群体。在所有研究的疾病预后因素中，肿瘤大小、核分级和增殖指数似乎与肿瘤复发密切相关。此外，原发性肿瘤的生物学特征，如激素和生长因子受体的存在、特定多肽和蛋白酶的分泌、原癌基因的表达以及肿瘤抑制基因的异常，已被证明可能作为早期乳腺癌患者的预后指标。尽管有这些引人注目的数据，但在将这些参数纳入腋窝淋巴结阴性乳腺癌患者的常规评估之前，还需要进行更大规模的临床试验。
