Chadha M, Chabon A B, Friedmann P, Vikram B
Department of Radiation Oncology, Beth Israel Medical Center, New York, NY 10003.
Cancer. 1994 Jan 15;73(2):350-3. doi: 10.1002/1097-0142(19940115)73:2<350::aid-cncr2820730219>3.0.co;2-5.
In T1 tumors, the reported incidence of lymph node metastases ranges from 21% to 35%. The authors analyzed the pathology parameters of T1 tumors for their association with the likelihood of axillary lymph node metastases.
Two hundred sixty-three patients with T1 unilateral invasive breast cancer were studied. All underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor evaluated included size, histologic subtype, nuclear grade, DNA ploidy, S-phase fraction (SPF), hormone receptor status, lymphatic/vascular invasion (LVI), and host reaction.
Seventy-two (27%) patients had nodes that were positive for metastasis. Univariate analysis showed that lymph node metastases were associated with tumors larger than 1 cm (P = 0.001), moderate or poorly differentiated nuclear grade (P = 0.005), high SPF (P = 0.041), presence of LVI (P < 0.001) and patients younger than 60 years (P = 0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size and LVI. Twenty-five patients had tumors larger than 1.0 cm and presence of LVI; of these, 17 (68%) had lymph node metastases. Of the 79 patients who had neither of these features, only 7 (9%) had lymph node metastases.
The authors conclude that characteristics of the primary tumor can help assess the risk for axillary lymph node metastases. Selected patients who are assessed to be at minimal risk might be spared routine axillary dissection or radiation therapy to the axilla.
在T1期肿瘤中，报道的淋巴结转移发生率为21%至35%。作者分析了T1期肿瘤的病理参数与腋窝淋巴结转移可能性之间的关联。
对263例单侧T1期浸润性乳腺癌患者进行了研究。所有患者均接受了腋窝清扫术，且淋巴结的病理状态已知。评估的原发肿瘤参数包括大小、组织学亚型、核分级、DNA倍体、S期分数（SPF）、激素受体状态、淋巴/血管侵犯（LVI）和宿主反应。
72例（27%）患者的淋巴结有转移。单因素分析显示，淋巴结转移与肿瘤大于1 cm（P = 0.001）、核分级为中等或低分化（P = 0.005）、高SPF（P = 0.041）、存在LVI（P < 0.001）以及年龄小于60岁的患者（P = 0.01）相关。然而，多因素逻辑回归分析中淋巴结转移的独立预测因素是肿瘤大小和LVI。25例患者的肿瘤大于1.0 cm且存在LVI；其中17例（68%）有淋巴结转移。在79例既无上述特征的患者中，只有7例（9%）有淋巴结转移。
作者得出结论，原发肿瘤的特征有助于评估腋窝淋巴结转移的风险。经评估风险极小的特定患者可能无需进行常规腋窝清扫术或腋窝放疗。
