PROGNOSTIC-SIGNIFICANCE OF PERITUMORAL VESSEL INVASION IN CLINICAL-TRIALS OF ADJUVANT THERAPY FOR BREAST-CANCER WITH AXILLARY LYMPH-NODE METASTASIS
PROGNOSTIC-SIGNIFICANCE OF PERITUMORAL VESSEL INVASION IN CLINICAL-TRIALS OF ADJUVANT THERAPY FOR BREAST-CANCER WITH AXILLARY LYMPH-NODE METASTASIS
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DOI：
10.1016/s0046-8177(85)80033-2
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发表时间：
1985-01-01
期刊：
影响因子：
3.3
通讯作者：
RUDENSTAM, CM
中科院分区：
文献类型：
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作者：
DAVIS, BW;GELBER, R;RUDENSTAM, CM
为了评估肿瘤周围血管浸润的预后意义，我们检查了1510名妇女的数据，这些妇女参加了路德维希乳腺癌组试验I至IV，以评估辅助治疗可手术的伴有腋窝淋巴结转移的乳腺癌。通过常规光镜检查，59%（1510例中889例）的患者发现肿瘤细胞浸润血管，并且在绝经前/围绝经期（60%，778例中468例）和绝经后（58%，732例中421例）的女性中分布均匀。在logrank分析中，按淋巴结状态分层（1 - 3个或4个或更多阳性淋巴结），血管侵犯患者的4年无病生存率（DFS）明显低于无血管侵犯的女性（50%对65%，P < 0.0001）。绝经前/围绝经期（P = 0.0004）和绝经后（P = 0.0002）患者的DFS差异均可见。对于绝经前/围绝经期（P = 0.002）和绝经后（P = 0.04）的女性，血管侵犯患者的四年总生存率较低（71%对82%，P = 0.0006）。血管浸润的存在与腋窝淋巴结阳性数量增加、肿瘤分级上升、非星状肿瘤边界生长模式和原发肿瘤中类固醇激素受体含量升高显著相关。在控制治疗方案、淋巴结状态、肿瘤大小、雌激素受体状态、绝经状态和年龄的多变量模型中，评估肿瘤周围血管侵犯对DFS （P < 0.0001）和总生存率（P = 0.003）仍然具有预后意义。根据亚群的不同，有血管侵犯的患者治疗失败的风险比没有血管侵犯的患者高41%至54%，死亡风险高29%至64%。有血管侵犯的女性远端治疗失败的比例高于无血管侵犯的女性（27%对18%，P = 0.003）。在腋窝淋巴结转移的患者中，瘤周血管浸润可能是全身性疾病负担增加的标志。
To assess the prognostic significance of peritumoral vessel invasion, data were examined for 1,510 women entered into the Ludwig Breast Cancer Group Trials I to IV evaluating adjuvant therapy for operable breast cancer with axillary nodal metastasis. Vessel invasion by tumor cells was identified by routine light microscopy in 59 per cent (889 of 1,510) of the patients and was equally distributed between premenopausal/perimenopausal (60 per cent, 468 of 778) and postmenopausal (58 per cent, 421 of 732) women. In logrank analyses stratified by nodal status (one to three or four or more positive nodes), the four-year disease- free survival (DFS) rate was significantly lower in patients with vessel invasion than in women without vessel invasion (50 per cent versus 65 per cent, P < 0.0001). This DFS difference was seen for both premenopausal/perimenopausal (P = 0.0004) and postmenopausal (P = 0.0002) patients. The four-year overall survival rate was lower in patients with vessel invasion (71 per cent versus 82 per cent, P = 0.0006), both for premenopausal/perimenopausal (P = 0.002) and postmenopausal (P = 0.04) women. The presence of vessel invasion was significantly associated with increasing numbers of positive axillary lymph nodes, rising tumor grade, nonstellate tumor border growth pattern, and higher steroid hormone receptor content of the primary tumor. The assessment of peritumoral vessel invasion continued to have prognostic significance for DFS (P < 0.0001) and overall survival (P = 0.003) when evaluated in multivariate models controlling for treatment assigned, nodal status, tumor size, estrogen receptor status, menopasual status, and age. Depending on the subpopulation, patients with vessel invasion had a 41 per cent to 54 per cent greater risk of treatment failure than those without vessel invasion and a 29 per cent to 64 per cent greater risk of death. The percentage of treatment failures at distant sites was higher for women with than for those without vessel invasion (27 per cent versus 18 per cent, P = 0.003). In patients with axillary lymph node metastases, peritumoral vessel invasion may be a sign of increased systemic disease burden.