Lee A K, Loda M, Mackarem G, Bosari S, DeLellis R A, Heatley G J, Hughes K
Department of Pathology, Lahey-Hitchcock Clinic, Burlington, Massachusetts 01805, USA.
Cancer. 1997 Feb 15;79(4):761-71.
Patients with lymph node negative invasive breast carcinomas < or = 1 cm in size have a low recurrence rate and may be spared adjuvant therapy. Reliable prognostic features will help physicians design appropriate treatment for these patients.
The clinicopathologic features, prognostic marker profiles, and clinical outcomes of 88 T1a,bN0M0 carcinomas in 87 patients who presented between 1975 and 1990 were studied. The size of each tumor was determined by direct measurement of histologic sections. The median follow-up was 7.8 years (range, 4-15 years). The characteristics of tumors diagnosed between 1975 and 1983 and between 1984 and 1990 were also compared.
Before 1984, the majority of patients presented with palpable mass lesions, whereas from 1984 on, more patients presented with mammographic abnormalities. However, no significant differences in the pathologic features of tumors were observed between the two periods. There were only 3 locoregional recurrences (3%) and 4 distant recurrences (5%). Palpable tumors had worse prognoses than mammographically detected lesions (P = 0.02). Histologic grade, lymphatic invasion, hormone receptors, Ki-67 antigen, and bcl-2 expression were significant univariate prognostic indicators. The small number of patients in the series precluded multivariate analysis. None of the 43 patients (49%) with tumors < or = 0.5 cm, or of histologic and nuclear Grade 1, or of favorable histologic types developed recurrences; and their outcomes were significantly better than those of other patients (P = 0.013). Tumors originally classified as T1b, but which exceeded 1 cm on review and were excluded from the study, had a significantly higher distant recurrence rate (23%) than bona fide T1a,b carcinomas (P = 0.03).
T1a,bN0M0 carcinomas have a low recurrence rate, especially those tumors < or = 0.5 cm, or of low histologic or nuclear grade, or of favorable histologic type. The high recurrence among patients with tumors initially understaged as T1a,b carcinoma underscores the importance of accurately determining tumor size.
肿瘤大小小于或等于1厘米且淋巴结阴性的浸润性乳腺癌患者复发率较低，可能无需辅助治疗。可靠的预后特征将有助于医生为这些患者设计合适的治疗方案。
对1975年至1990年间87例患者的88例T1a、bN0M0癌的临床病理特征、预后标志物谱及临床结局进行研究。通过对组织切片的直接测量确定每个肿瘤的大小。中位随访时间为7.8年（范围4 - 15年）。还比较了1975年至1983年以及1984年至1990年间诊断的肿瘤特征。
1984年前，大多数患者表现为可触及的肿块病变，而从1984年起，更多患者表现为乳房X线检查异常。然而，两个时期肿瘤的病理特征未观察到显著差异。仅3例局部区域复发（3%）和4例远处复发（5%）。可触及的肿瘤预后比乳房X线检查发现的病变差（P = 0.02）。组织学分级、淋巴管浸润、激素受体、Ki-67抗原和bcl-2表达是显著的单因素预后指标。该系列患者数量较少，无法进行多因素分析。43例肿瘤小于或等于0.5厘米、或组织学和核分级为1级、或组织学类型良好的患者均未复发；其结局明显优于其他患者（P = 0.013）。最初分类为T1b但复查时超过1厘米并被排除在研究之外的肿瘤，远处复发率（23%）明显高于真正的T1a、b癌（P = 0.03）。
T1a、bN0M0癌复发率较低，尤其是那些肿瘤小于或等于0.5厘米、或组织学或核分级低、或组织学类型良好的肿瘤。最初分期为T1a、b癌的患者中复发率较高，凸显了准确确定肿瘤大小的重要性。
