淋巴结转移率对腋窝淋巴结阳性乳腺癌的预后意义  

Prognostic significance of lymph node ratio in axillary lymph node positive breast cancer

作　　者：陈宏亮[1] 丁昂[1] 王懋莉[1] 张征[1] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011

出　　处：《中国综合临床》2016年第3期238-243,共6页Clinical Medicine of China

摘　　要：目的探讨淋巴结转移率（LNR）对腋窝淋巴结阳性的乳腺癌的预后意义。方法选取2006-2014年在我院进行系统治疗的腋窝淋巴结阳性的乳腺癌803例作为研究对象，无远处转移，且清扫淋巴结数目至少为10枚。统计5年无病生存率（5y-DFSR）及5年总生存率（5y—OSR）；通过单因素方法分析影响预后的各项因素；分析腋窝淋巴结病理分期（pN分期）中不同LNR分级的病例的预后差异；通过多因素分析比较pN及LNR对预后的影响作用。结果803例腋窝淋巴结阳性乳腺癌患者平均清扫淋巴结总数为（15．47±4．70）枚，中位阳性淋巴结数目为4枚。中位随访61个月，期间发生局部复发和远处转移共159例，发生乳腺癌相关性死亡共99例。5y—DFSR为77％，5y—OSR为83％。通过Log-rank单因素分析得出肿瘤直径（pT）、淋巴结分期（pN）、LNR、脉管侵犯以及雌激素受体状态是DFS及OS的影响因素。pN1、pN2、pN3的5y-DFSR和5y-OSR分别为：89％、68％、59％和93％、78％、63％；LNR1、LNR2、LNR3的5y—DFSR和5y-OSR分别为：90％、69％、56％和94％、80％、57％。pN1及pN2中，不同LNR分级病例的预后差异具有统计学意义（pN1：DFS：P=0．005，OS：P=0．024；pN2：DFS：P=0．017，OS：P=0．000），而pN3中不同LNR分级病例的预后尽管在生存曲线中显示出差异趋势，但尚未达到统计学意义（DFS：P=0．165，OS：P=0．075）。将pN与LNR分别纳入多因素分析，两者均是DFS和OS独立的预后因素（P均〈0．001）；将pN与LNR同时纳入多因素分析，LNR依然是DFS和OS独立的预后因素（P〈0．001），而pN则不再是其独立的预后因素（DFS：P=0．461，OS：P=0．162）。结论LNR是淋巴结阳性的乳腺癌独立的预后因素。Objective To evaluate the prognostic significance of lymph node ratio （LNR） in axillary lymph node positive breast cancer. Methods Eight hundred and three cases axillary lymph node positive breast cancer patients without distant metastasis were systematically treated in the Obstetrics and Gynecology Hospital of Fudan University from 2006 to 2014, at least 10 lymph node removed in each case. Clinicopathological data including 5-year disease-free survival rate （5y-DFSR） and 5-year overall survival rate （5y-OSR） were described. Factors related with prognosis were analyzed by univariate analysis. Prognostic difference was compared among different LNR stage in each axillary lymph node pathological stage（pN）. Prognostic significance of pN and LNR was compared by multivariate analysis. Results Mean lymph nodes removed were 15.47±4.70 lymph, and median positive lymph nodes were 4 lymph in 803 cases axillary lymph node positive breast cancer patients. Altogether 159 cases of local recurrence and distant metastasis and 99 cases of breast cancer-related death occurred during median follow-up of 61 months. Five-year DFSR was 77% and 5y-OSR was 83%. Log-rank univariate analysis showen that pT, pN, LNR, lymphovascular invasion and ER status were related to DFS and OS. Five-year DFSR and OSR for pN1, pN2, pN3 were 89%, 68%, 59% and 93%, 78%, 63%, respectively, whereas 5y-DFSR and 5y-OSR for LNR1, LNR2, LNR3 were 90%, 69%, 56% and 94%, 80%, 57%, respectively. There was statistically significant difference among different LNR in pN1 and pN2 （pNI：DFS：P = 0. 005, OS ： P = 0. 024 ; pN2 ： DFS ： P = 0. 017, OS ： P = 0. 000） , but not in pN3, inspite of difference tendency （ DFS ： P = 0. 165, OS ： P = 0. 075）. In multivariate analysis, when pN or LNR were entered into the Cox regression mode respectively, both were the independent prognostic factors of DFS（ P〈0. 001 ） and OS （P〈0. 001 ）. WhenpN and LNR were entered into the Cox hazard regression model at the same time, LNR remained a

关 键 词：乳腺癌 淋巴结转移率 淋巴结分期 预后 

分 类 号：R737.9[医药卫生—肿瘤]