摘要
目的 探讨腋窝淋巴结结外侵犯（extranodal extension of axillary lymph nodes,ALN-ENE）对原发性浸润性乳腺癌术后淋巴结转移患者预后的影响.方法 回顾性分析河北医科大学第四医院2006年1月至2008年12月间确诊为原发性非特殊型浸润性乳腺癌患者638例,观察淋巴结转移及ALN-ENE情况,并分析其与患者临床病理特征及预后的关系.结果 638例患者中,263例（41.2%）存在淋巴结转移,其中91例（34.6%）存在ALN-ENE.随着肿瘤大小、淋巴结转移个数、淋巴结转移率的增加,ALN-ENE发生率升高（均P〈0.05）.ALN-ENE阳性组患者5年无复发生存率（RFS）为86.6%,5年总生存率（OS）为91.2%,较ALN-ENE阴性组明显降低,差异有统计学意义（P〈0.01）.149例淋巴结转移个数≤3枚,ALN-ENE阳性组患者5年RFS为91.9%、5年OS为92.3%,较阴性组明显降低,差异有统计学意义（P〈0.01）.多因素生存分析结果显示,淋巴结转移个数及发生ALN-ENE是影响患者RFS及OS的独立危险因素（P〈0.05）,对于淋巴家转移≤3枚患者,ALN-ENE是影响RFS及OS的独立危险因素（P〈0.01）.结论 腋窝淋巴结转移个数仍然是影响乳腺癌患者预后的重要因素之一,而ALN-ENE是一个预测乳腺癌患者复发风险和生存期的独立指标之一,对于≤3枚淋巴结转移的患者,ALN-ENE有可能改变患者的临床病理分期,是判断该组患者预后的独立指标.
Objective To investigate the significance of extranodal extension of axillary lymph nodes （ALN-ENE） metastases in post-operative primary invasive breast carcinoma of non-specific type.Methods Six hundred and thirty-eight invasive breast cancer cases confirmed by postoperative pathological examination were collected from January 2006 to December 2008.The relationship of lymph node metastases and ALN-ENE with other lymph node parameters and patient outcome was analyzed.Results Among 638 cases, 263 （41.2%） showed axillary lymph node metastases.ALN-ENE was present in 91 cases （36.4%）.The rate of ALN-ENE increased with pT stage and tumor size.Five-year recurrence-free survival rate （RFS） and 5-year overall survival rate （OS） was 86.6% and 91.2% respectively for ALN-ENE positive group, and both were lower than ALN-ENE negative group （P〈0.01）.One hundred and forty-nine patients with 1 to 3 positive lymph nodes had a 5-year RFS of 91.9%, and 5-year OS of 92.3%, less than ALN-ENE negative group （P〈0.01）.Univariate analysis showed ALN-ENE positively correlated with lymph node metastasis.Multivariate analysis suggested that ENE was associated with increased recurrence risk and shortened recurrence-free and overall survival, especially in patients with 1 to 3 positive lymph nodes;and it was an independent prognostic factor （P〈0.01）.Conclusions The number of lymph nodes metastases is an important predictor of survival in breast cancer patients.ALN-ENE is an independent risk indicator for recurrence and overall survival.For patients with 1 to 3 metastatic axillary lymph nodes, ALN-ENE could alter the patient′s clinical pathologic staging, and therefore it is an independent prognostic factor.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2017年第8期525-529,共5页
Chinese Journal of Pathology
基金
2016年度河北省卫计委医学科学研究重点课题计划项目（20160189）
2016年河北省卫计委政府资助省级临床医学优秀人才项目（2016034798）
关键词
乳腺肿瘤
淋巴转移
预后
Breast neoplasms
Lymphatic metastasis
Prognosis
