乳腺癌腋窝淋巴结结外侵犯程度分级初步探讨  

Classification of extranodal extension of axillary lymphnodes in breast cancer

作　　者：张玲玲[1] 蔡丽静 邓会岩 马力[2] 郭玉玮 刘月平[1] ZHANG Ling-ling;CAI Li-jing;DENG Hui-yan;MA Li;GUO Yu-wei;LIU Yue-ping(Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,P.R.China)

机构地区：[1]河北医科大学第四医院病理科,河北石家庄050011 [2]河北医科大学第四医院乳腺中心,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2019年第20期1551-1557,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的原发浸润性乳腺癌患者出现腋窝淋巴结结外侵犯(extranodal extension,ENE)可能增加其不良预后风险,但这一特征并没有量化。本研究将腋窝淋巴结ENE的程度进行分级并探讨其预后预测价值。方法选取河北医科大学第四医院2008-01-01-2009-12-31行根治性乳腺切除术的腋窝淋巴结转移阳性的原发性非特殊型浸润性乳腺癌(invasive breast carcinoma of no specific type,IBC-NST)患者459例,显微镜观察淋巴结转移及腋窝淋巴结ENE情况。将腋窝淋巴结ENE的程度分为3级:不存在ENE为0级;单个淋巴结被膜侵犯长度≤淋巴结周长的1/3为1级;单个淋巴结被膜侵犯长度>淋巴结周长的1/3,或全部淋巴结受累为2级。记录结果并与其他病理危险因素建立数据库分析其预后意义。结果全组459例患者腋窝淋巴结ENE阴性者占59.48%(273/459),ENE阳性者占40.52%(186/459)。其中程度1级者占45.16%(84/186),2级者占54.84%(102/186)。结果显示,组织分化越低、肿瘤最大径越大、淋巴结转移数及淋巴结转移率越高、临床分期越晚,ENE 2级患者比例越高;脉管瘤栓阳性患者ENE 2级的阳性率高于脉管瘤栓阴性患者,差异均有统计学意义,P<0.05。生存分析结果显示,ENE阴性者5年无病生存率(disease-free survival,DFS)和总体生存率(overall survival,OS)分别为90.29%和94.31%,1级者5年DFS、OS分别为71.63%和88.10%,2级者5年DFS、OS分别为31.32%和64.08%。多因素生存分析结果显示,腋窝淋巴结ENE程度是患者DFS和OS的独立危险因素(DFS:HR=2.960,95%CI:2.333~3.775,P<0.01;OS:HR=2.533,95%CI:1.836~3.495,P<0.01)。结论腋窝淋巴结ENE是乳腺癌患者预后不良的重要因素之一,ENE程度分级能客观反映腋窝淋巴结ENE状态,有望作为乳腺癌预后预测指标应用于临床。OBJECTIVE Extranodal extension(ENE)of anxillary lymphnodes in patients with primary invasive breast cancer may increase the risk of poor prognosis,but this feature has not been quantified.This study classified the extent of ENE and explored its prognostic value.METHODS A total of 459 patients of primary non-specific breast cancer(IBC-NST)with axillary lymph node metastasis-positive underwent radical mastectomy was selected from January 1 st,2008 to December 31 st,2009 in the Fourth Hospital of Hebei Medical University.The lymph node metastasis and ENE of anxillary lymphnodes were observed by microscope.The degree of ENE was divided into 3 levels:no ENE was grade 0,ENE was graded as grade 1 if the capsule of the lymph node(LN)was ruptured less than one-third of its circumference,if the capsule was disrupted more than one-third of its circumference or the entire LN was disrupted as grade 2.The results were recorded and compared with other pathological risk factors.The prognostic significance was analyzed by KaplanMeier method,Log-rank test and univariate and multivariate Cox risk proportional regression model.RESULTS Of the459 patients,59.48%(273/459)were negative for ENE of anxillary lymphnodes.The incidence rate of ENE was 40.52%(186/459),of which 45.16%(84/186)was grade 1 and 54.84%(102/186)was grade 2.The results showed that the higher positive rate of ENE 2 was closely related to lower tissue differentiation,larger tumor size,higher lymph node metastasis and lymph node metastasis rate and later clinical stage.Patients with grade 2 were more frequently associated with positive vascular invasion(P<0.05).Kaplan-Meier survival analysis showed that the 5-year DFS and OS of ENE negative patients were 90.29% and 94.31%,which were 71.63%and 88.10%in grade 1,31.32%and 64.08%in grade2 patients.Cox multivariate survival analysis showed that ENE was an independent risk factor for DFS and OS(DFS:HR=2.960,95%CI:2.333-3.775,P<0.01;OS:HR=2.533,95%CI:1.836-3.495,P<0.01).CONCLUSIONS Patients with ENE have a poor outcome.The deg

关 键 词：非特殊型浸润性乳腺癌 淋巴结转移 腋窝淋巴结 结外侵犯 预后 

分 类 号：R737.9[医药卫生—肿瘤]