Sosa J A, Diener-West M, Gusev Y, Choti M A, Lange J R, Dooley W C, Zeiger M A
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ann Surg Oncol. 1998 Mar;5(2):140-9. doi: 10.1007/BF02303847.
The role of axillary lymph node dissection for stage I (T1N0) breast cancer remains controversial because patients can receive adjuvant chemotherapy regardless of their nodal status and because its therapeutic benefit is in question. The purpose of this study was to determine whether extent of axillary dissection in patients with T1N0 disease is associated with survival.
Data from 464 patients with T1N0 breast cancer who underwent axillary dissection from 1973 to 1994 were examined retrospectively. Kaplan-Meier estimates of overall survival, disease-free survival, and recurrence were calculated for patients according to the number of lymph nodes removed (<10 or > or = 10; <15 or > or = 15), and survival curves compared using the Wilcoxon-Gehan statistic. Cox proportional hazards regression modelling was used to adjust for confounding prognostic variables.
Median follow-up time was 6.4 years. Patient groups were similar in age, menopausal status, tumor size, hormonal receptor status, type of surgery, and adjuvant therapy. There was a statistically significant improvement in disease-free survival in the > or = 10 versus <10 nodal groups (P <.01). Five-year estimates of survival were 75.7% and 86.2% for <10 nodes and > or = 10 nodes, respectively; 10-year estimates were 66.1% and 74.3%. There also was a notable improvement in the survival comparison of patients with <15 versus > or = 15 nodes (P < or = .05). These findings were confirmed in the multivariate analysis.
These results may reflect a potential for misclassification of tumor stage among patients who had fewer nodes removed. The data, however, suggest that in patients with Stage I breast cancer, improved survival is associated with a more complete axillary lymph node dissection.
对于Ⅰ期（T1N0）乳腺癌患者，腋窝淋巴结清扫术的作用仍存在争议，这是因为无论患者的淋巴结状态如何都可接受辅助化疗，且其治疗益处也受到质疑。本研究的目的是确定T1N0疾病患者腋窝清扫范围是否与生存率相关。
回顾性分析了1973年至1994年间接受腋窝清扫术的464例T1N0乳腺癌患者的数据。根据切除淋巴结的数量（<10个或≥10个；<15个或≥15个）计算患者的总生存、无病生存和复发的Kaplan-Meier估计值，并使用Wilcoxon-Gehan统计量比较生存曲线。采用Cox比例风险回归模型对混杂的预后变量进行校正。
中位随访时间为6.4年。患者组在年龄、绝经状态、肿瘤大小、激素受体状态、手术类型和辅助治疗方面相似。≥10个淋巴结组与<10个淋巴结组相比，无病生存有统计学显著改善（P<.01）。<10个淋巴结和≥10个淋巴结患者的5年生存率估计分别为75.7%和86.2%；10年生存率估计分别为66.1%和74.3%。<15个淋巴结与≥15个淋巴结患者的生存比较也有显著改善（P≤.05）。这些结果在多变量分析中得到证实。
这些结果可能反映了淋巴结切除较少的患者中肿瘤分期存在错误分类的可能性。然而，数据表明，对于Ⅰ期乳腺癌患者，更彻底的腋窝淋巴结清扫与生存率提高相关。
