Barth A, Craig P H, Silverstein M J
Institute of Medical Oncology, University of Bern, Switzerland.
Cancer. 1997 May 15;79(10):1918-22.
Axillary lymph node metastases (ALNM) are the most important predictor of survival in patients with T1 breast carcinoma. Due to a relatively low incidence of axillary metastasis in tumors < or = 2 cm, the role of axillary lymph node dissection for these patients has been questioned. The purpose of this study was to determine the association between the incidence of ALNM and 11 clinical/pathologic factors by univariate and multivariate analysis.
The authors reviewed data from 918 patients with T1 breast carcinoma who underwent level I/II axillary dissection between 1979 and July 1995. The association between the incidence of ALNM and 11 clinical/pathologic factors (size, lymph/vascular invasion, nuclear grade, S-phase, ploidy, palpability, age, estrogen receptor status, progesterone receptor status, HER-2/neu, and histology) was analyzed by univariate and, when significant, by multivariate analysis.
Approximately 23% of the 918 patients with T1 breast carcinoma had ALNM. Multivariate analysis identified four factors as independent predictors of ALNM: lymph/vascular invasion (P < 0.0001), tumor palpability (P < 0.0001), nuclear grade (P = 0.0004), and tumor size (P = 0.01). Among the 117 patients with nonpalpable, nonhigh grade tumors < or = 1 cm without lymph/vascular invasion, the incidence of ALNM was only 3%. However, the 43 patients with T1c tumors with all 3 additional risk factors had a 49% incidence of ALNM.
Clinical and pathologic features of the primary tumor can be used to estimate the risk of ALNM in patients with T1 breast carcinoma. Such a risk assessment might facilitate appropriate management. Routine axillary dissection can be omitted in patients at minimal risk of ALNM, if the treatment decision is not influenced by lymph node status. Axillary lymph node dissection should be performed routinely for all patients with lesions > 1 cm. [See editorial counterpoint on pages 1856-61 and reply to counterpoint on pages 1862-4, this issue.]
腋窝淋巴结转移（ALNM）是T1期乳腺癌患者生存的最重要预测指标。由于肿瘤直径≤2 cm时腋窝转移发生率相对较低，腋窝淋巴结清扫术对这些患者的作用受到质疑。本研究的目的是通过单因素和多因素分析确定ALNM发生率与11项临床/病理因素之间的关联。
作者回顾了1979年至1995年7月间接受I/II级腋窝清扫术的918例T1期乳腺癌患者的数据。通过单因素分析以及在有显著性差异时通过多因素分析，分析ALNM发生率与11项临床/病理因素（肿瘤大小、淋巴管/血管侵犯、核分级、S期、倍体、可触及性、年龄、雌激素受体状态、孕激素受体状态、HER-2/neu和组织学）之间的关联。
918例T1期乳腺癌患者中约23%发生了ALNM。多因素分析确定了四个因素为ALNM的独立预测指标：淋巴管/血管侵犯（P<0.0001）、肿瘤可触及性（P<0.0001）、核分级（P = 0.0004）和肿瘤大小（P = 0.01）。在117例肿瘤不可触及、非高级别、直径≤1 cm且无淋巴管/血管侵犯的患者中，ALNM发生率仅为3%。然而，43例具有所有3项额外危险因素的T1c期肿瘤患者，ALNM发生率为49%。
原发肿瘤的临床和病理特征可用于评估T1期乳腺癌患者发生ALNM的风险。这种风险评估可能有助于进行适当的治疗管理。如果治疗决策不受淋巴结状态影响，对于ALNM风险极低的患者可省略常规腋窝清扫术。对于所有病变直径>1 cm的患者应常规进行腋窝淋巴结清扫术。[见本期第1856 - 1861页的编辑观点及第1862 - 1864页对观点的回应。]
