淋巴结转移密度与乳腺浸润性导管癌预后的关系  

Relationship between lymph node metastasis density and prognosis in patients with invasive ductal carcinoma of breast

作　　者：李世君[1] 王月华[1] 常苗苗[1] 赵蒙[1] 王学智[2] 

机构地区：[1]内蒙古医科大学赤峰临床医学院病理科,赤峰024000 [2]内蒙古医科大学赤峰临床医学院肿瘤外科,赤峰024000

出　　处：《临床与实验病理学杂志》2016年第3期268-271,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨淋巴结转移密度与手术治疗乳腺浸润性导管癌患者预后的关系。方法回顾性分析113例乳腺浸润性导管癌的临床资料,按淋巴结转移密度分为ND>40组、ND=0组和ND≤40组,采用Kaplan-Meier法和Cox比例风险模型,比较临床病理特征及淋巴结转移密度评价手术治疗乳腺浸润性导管癌患者5年无瘤生存率和总生存率的价值。结果 ND>40组、ND=0组和ND≤40组5年无瘤生存率及总生存率,差异有统计学意义(P均<0.05)。在Ⅲ期乳腺癌患者中,淋巴结转移密度提供良好的分层意义,ND>40组Ⅲ期乳腺癌与Ⅳ期乳腺癌预后无差异(P=0.453)。单因素分析显示,脉管癌栓、淋巴结转移密度、TNM分期、雌、孕激素受体状态及p N分期均与患者的5年无瘤生存率和总生存率有关(P均<0.05)。多因素分析显示,组织学分级及淋巴结转移密度是影响患者5年无瘤生存率的独立因素(P均<0.05);淋巴结转移密度是影响患者5年总生存率的独立因素(P<0.05)。结论淋巴结转移密度是手术治疗乳腺浸润性导管癌患者预后的独立因素,提示其可作为乳腺癌预后的参考标准,ND>40组提示预后不良。Purpose To investigate the relationship between lymph node metastasis density and prognosis in patients with invasive duc- tal carcinoma of breast. Method The clinical data of 113 patients with invasive ductal carcinoma of breast were analysed retrospec- tively. The density of lymph node metastasis is divided into ND 〉 40 groups, ND = 0 and ND≤40 groups. Survival analysis was per- formed with Kaplan-Meier and Cox proportional hazard model. The 5-year disease-free survival （DFS） and overall survival （OS） were compared based on the lymph node metastasis density and clinical pathologic characteristics in patients who underwent surgery with in- vasive ductal carcinoma. Result There had a statistical difference of DFS and OS among ND 〉40 group, ND =0 group and ND≤40 group （P 〈 0.05 for all）. Interestingly, lymph node metastasis density provided excellent prognostic stratification within stage m breast cancer patients, and stage m with ND 〉 40 predicted a similar prognosis to stage IV （ P = 0. 453 ）. Univariate analysis showed that vessel carcinoma embolus, lymph node metastasis density, TNM stage, ER/PR status and pN stage were significant prognostic factors for 5-years DFS and OS （ P 〈 0. 05 for all）. Multivariate analysis indicated that histological grade and lymph node metastasis density were independent prognostic factors for 5-years DFS （P 〈 0. 05 for all）. Lymph node metastasis density was an independent prognostic factor for 5-years OS （ P 〈 0. 05 ）. Conclusion The lymph node metastasis density is the independent factor which affecting the prog- nosis of patients who underwent surgery with invasive ductal carcinoma of breast, which suggest lymph node metastasis density can be used as a reference standard in the prognosis of breast cancer, and ND 〉 40 is associated with poor outcome.

关 键 词：乳腺肿瘤 浸润性导管癌 淋巴结转移密度 无瘤生存率 总生存率 预后 

分 类 号：R730.2[医药卫生—肿瘤]