Bolla M, Seigneurin D, Winckel P, Marron-Charrière J, Panh M H, Pasquier D, Ch-edin M, Payan R, Merlin F, Colonna M
Department of Radiotherapy, CHU de Grenoble, France.
Eur J Cancer. 1996 Sep;32A(10):1680-5. doi: 10.1016/0959-8049(96)00174-8.
Identifying prognostic markers in local regional breast carcinomas remains an important challenge today. DNA content obtained by flow cytometry, has been found to be of prognostic value; results with other methods remain less clear. This report describes DNA image cytometry patterns which are assessed with respect to disease-free survival. From June 1982 to December 1992, 415 patients under 75 years of age, without any previous or synchronous carcinoma, suffering from an invasive breast cancer classified as T1 (52.8%), T2 (47.2%), N0 (65.1%) N1 (34.9%), MO according to clinical TNM staging, were enrolled in this study. The median age was 53 (28-75) and 58.8% of the patients were premenopausal; 85.3% underwent a breast conservative procedure and 14.7% a modified radical mastectomy followed by postoperative irradiation. Histological axillary lymph node status, Scarff-Bloom grade and/or cytological grade and, oestrogen receptor content were used in decision-making for adjuvant treatment: hormonotherapy (48%) or chemotherapy (18.8%). Imprints were taken from the macroscopically visible lesion at the time of surgery, and a Feulgen staining was carried out on air dried smears to be analysed using the Samba 200 cell image processor (Alcatel TITN, France). Five parameters were systematically assessed: proliferation index; DNA histogram, integrated optical density, DNA malignancy grade, ploidy balance. With a median follow-up of 36 months (0-105), proliferation index (P = 0.0008), DNA histogram (P = 0.0017), integrated optical density (IOD) (P = 0.018) and DNA malignancy grade (P = 0.017) had a significant prognostic value on disease-free survival estimated by the Kaplan-Meier method. When these parameters were included in a Cox proportional regression hazards model, PR (P = 0.01), Scarff-Bloom histological grading (P = 0.02), axillary clearance (P = 0.04) were significant; however, in the same model, taking into account the axillary lymph node histological status, IOD was significant for pN- patients (P = 0.03), and proliferation index (P = 0.03) was significant for pN+. Such results need to be updated with a longer median follow-up, but they suggest that the mean DNA content, as measured by the integrated optical density (IOD), should be considered when deciding on medical adjuvant treatment with respect to patients with a negative axillary clearance.
如今，识别局部区域性乳腺癌的预后标志物仍是一项重大挑战。通过流式细胞术获得的DNA含量已被发现具有预后价值；其他方法的结果仍不太明确。本报告描述了根据无病生存期评估的DNA图像细胞术模式。从1982年6月至1992年12月，415例75岁以下、既往无任何癌症且无同步癌症的浸润性乳腺癌患者纳入本研究，根据临床TNM分期，这些患者被分类为T1（52.8%）、T2（47.2%）、N0（65.1%）、N1（34.9%）、M0。中位年龄为53岁（28 - 75岁），58.8%的患者为绝经前；85.3%的患者接受了保乳手术，14.7%的患者接受了改良根治性乳房切除术并术后放疗。组织学腋窝淋巴结状态、斯卡夫-布卢姆分级和/或细胞学分级以及雌激素受体含量用于辅助治疗的决策：激素治疗（48%）或化疗（18.8%）。在手术时从肉眼可见的病变处获取印记，并对空气干燥涂片进行福尔根染色，使用Samba 200细胞图像处理器（法国阿尔卡特TITN）进行分析。系统评估了五个参数：增殖指数；DNA直方图、积分光密度、DNA恶性度分级、倍体平衡。中位随访36个月（0 - 105个月），增殖指数（P = 0.0008）、DNA直方图（P = 0.0017）、积分光密度（IOD）（P = 0.018）和DNA恶性度分级（P = 0.017）对采用Kaplan - Meier方法估计的无病生存期具有显著的预后价值。当将这些参数纳入Cox比例回归风险模型时，增殖指数（P = 0.01）、斯卡夫-布卢姆组织学分级（P = 0.02）、腋窝清扫（P = 0.04）具有显著性；然而，在同一模型中，考虑腋窝淋巴结组织学状态时，IOD对pN - 患者具有显著性（P = 0.03），增殖指数对pN + 患者具有显著性（P = 0.03）。这些结果需要通过更长的中位随访进行更新，但它们表明，对于腋窝清扫阴性的患者，在决定辅助药物治疗时应考虑通过积分光密度（IOD）测量的平均DNA含量。
