宋艳群, 张 斌, 赵洪猛, 曹旭晨. 乳腺癌结外浸润对不同水平腋窝淋巴结受累患者预后的影响[J]. 中国肿瘤临床, 2010, 37(15): 862-865. DOI: 10.3969/j.issn.1000-8179.2010.15.006
引用本文: 宋艳群, 张 斌, 赵洪猛, 曹旭晨. 乳腺癌结外浸润对不同水平腋窝淋巴结受累患者预后的影响[J]. 中国肿瘤临床, 2010, 37(15): 862-865. DOI: 10.3969/j.issn.1000-8179.2010.15.006
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SONG Yanqun, ZHANG Bin, ZHAO Hongmeng, CAO Xuchen. The Effect of Extracapsular Extension on the Prognosis of Different Pathologically-Positive Axillary Lymph Node Levels in Breast Cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(15): 862-865. DOI: 10.3969/j.issn.1000-8179.2010.15.006
Citation: SONG Yanqun, ZHANG Bin, ZHAO Hongmeng, CAO Xuchen. The Effect of Extracapsular Extension on the Prognosis of Different Pathologically-Positive Axillary Lymph Node Levels in Breast Cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(15): 862-865. DOI: 10.3969/j.issn.1000-8179.2010.15.006
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乳腺癌结外浸润对不同水平腋窝淋巴结受累患者预后的影响

The Effect of Extracapsular Extension on the Prognosis of Different Pathologically-Positive Axillary Lymph Node Levels in Breast Cancer

    摘要
  • 摘要: 目的：研究淋巴结阳性浸润性乳腺癌患者，不同腋窝淋巴结受累水平下，淋巴结外浸润（Extracapsular extension，ECE ）对患者预后的影响。方法：回顾性分析术后病理证实腋窝淋巴结阳性的原发乳腺癌患者1 230 例，分层研究ECE 在不同腋窝淋巴结受累水平（LN1～3、LN4～9、LN≥10）对总生存率（Overall survival，OS）和无局部/区域复发率（Local-Regional failure free survial ，LRFFS ）的影响，并通过Cox 回归分析肿瘤大小、PER 及ECE 等对不同水平腋窝淋巴结受累患者预后的影响。结果：LN1～3 时，ECE 对OS及LRFFS 的影响均无统计学差异（P=0.931；P=0.591）。 LN4～9 时，ECE 对OS及LRFFS 的影响均有统计学差异（P=0.004；P=0.018）。 LN≥10时，ECE 对OS的影响有统计学意义（P=0.019），对LRFFS 的影响无显著性差异（P=0.094）。 Cox 回归分析对总体病例进行分析得出，肿瘤大小、PER 及ECE 均为有统计学意义的独立危险因素（P 均<0.05）。 分层分析得出，LN1～3 时，仅肿瘤大小有统计学意义（P=0.006）；LN4～9 时，仅ECE 有统计学意义（P=0.001）；LN≥10时，仅肿瘤大小、PER 有统计学意义（P 均<0.05）。 结论：ECE 是腋窝淋巴结阳性乳腺癌独立预后因素，其对不同水平淋巴结受累患者预后影响不同。对LN≥4 的患者，ECE 可作为判断预后的重要因素，尤其对LN4～9 患者，ECE 为预后不良的独立危险因素。ECE 对不同淋巴结受累水平患者的预后影响不同，可作为临床选择不同治疗方案的依据之一。

     

    Abstract: Objective:To evaluate the prognostic value of extracapsular extension (ECE) in different levels of pathologi -cally-positive axillary lymph nodes of breast cancer. Methods:The clinical records of 1,230 breast cancer patients with pathologically-positive lymph nodes treated with surgical therapy were retrospectively reviewed. The influence of ECE in overall survival (OS) and local-regional failure -ree survival (LRFFs) in different levels of pathologically-positive lymph nodes (LN 1～3, LN 4～9, LN ≥10) were investigated. COX regression model was used to analyze the relationship be-tween tumor size, positive-exampled rate (PER), ECE and the prognosis. Results: In the 1~3 positive lymph nodes group, ECE had no significant influence on OS and LRFFS (P=0.9308; P=0.5909). In the 4~9 positive lymph nodes group, ECE had significant influence on OS and LRFFS ( P=0.0036, P=0.0175). In the ≥10positive lymph nodes group, ECE had signif-icant influence on OS ( P=0.0188) but not on LRFFS (P=0.0938). Cox regression analysis revealed a significance for tumor size, PER and ECE for prognosis of the total samples (P≤0.05). In the 1~3 positive lymph nodes group, only tumor size had significant influence (P=0.006 ) ; in the 4~9 positive lymph nodes group, only ECE had significant influence (P = 0.001 ); while in the≥10positive lymph nodes group, tumor size and PER had significant influence (P≤0.05). Conclusion:ECE could be an independent prognostic factor for breast cancer and the prognostic value is different according to thelymph nodes involved. For the patients with ≥4 positive lymph nodes, ECE is of significance in predicting the prognosis. ECE is an independent risk factor of poor prognosis especially for the 4~9 positive lymph nodes group. As the different effect, it might be relevant to take into consideration the presence of ECE in the planning of adjuvant therapeutic modalities.

     

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