INDICATORS OF PROGNOSIS IN NODE-NEGATIVE BREAST-CANCER
INDICATORS OF PROGNOSIS IN NODE-NEGATIVE BREAST-CANCER
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DOI：
10.1056/nejm199004123221505
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发表时间：
1990-04-12
影响因子：
158.5
通讯作者：
OLSSON, H
中科院分区：
文献类型：
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作者：
SIGURDSSON, H;BALDETORP, B;OLSSON, H
肿瘤细胞增殖活性的测定对无淋巴结转移的乳腺癌患者有预后价值。我们研究了瑞典南部367名因此类癌症而接受手术切除的女性。用DNA流式细胞仪分析肿瘤标本的DNA含量(倍体)和处于细胞周期合成期(S期)的细胞比例。中位随访时间为四年；28%的患者接受了辅助治疗，通常是他莫昔芬(n=83)。一项基于250名患者完整数据的多变量分析包括以下协变量：年龄(.75、50到74和.ltoreq49岁)，肿瘤大小(.20对20 mM)，雌激素和孕激素受体浓度(<；10对.每毫克蛋白质10fmol)、倍性(二倍体与非二倍体)、S期类别(S期细胞的比例；7.0%至11.9%；12%)。S时相比例提供的预后信息最多，其次是孕激素受体状态和肿瘤大小。基于这三个变量的预后模型将37%的患者确定为高危人群，其远处复发的风险增加了四倍。在其余63%的患者中，5年总存活率(92.4%+.4%)与瑞典女性的预期年龄调整比率没有差别。我们的结论是，包括肿瘤细胞增殖活性指标的预后指数可能能够识别患有淋巴结阴性乳腺癌的女性，这些女性的复发风险足够低，可以避免辅助化疗。
Measures of the proliferative activity of tumor cells have prognostic value in patients with node-negative breast cancer. We studied 367 women in southern Sweden who had undergone surgical resection for such cancer. Tumor specimens were analyzed with DNA folow cytometry in order to estimate both the DNA content (ploidy) and the fraction of cells in the synthetic phase of the cell cycle (S phase). The median duration of follow-up was four years; 28 percent of the patients received adjuvant therapy, usually with tamoxifen (n = 83). A multivariate analysis based on complete data on 250 patients included the following covariates: age (.gtoreq. 75, 50 to 74, and .ltoreq. 49 years), tumor size (.ltoreq. 20 vs. > 20 mm), concentration of estrogen and progesterone receptors (< 10 vs. .gtoreq. 10 fmol per milligram of protein), ploidy (diploid vs. nondiploid), and S-phase category (fraction of cells in S phase; < 7.0 percent to 11.9 percent, and .gtoreq. 12 percent). The S-phase fraction yielded the most prognostic information, followed by progesterone-receptor status and tumor size. A prognostic model based on these three variables identified 37 percent of the patients as constituting a high-risk group with a fourfold increased risk of distant recurrence. In the remaining 63 percent of the patients, the five-year overall survival rate (92.+-.4 [.+-.SE] percent) did not differ from the expected age-adjusted rate for Swedish women. We conclude that a prognostic index that includes indicators of the proliferative activity of tumor cells may be able to identify women with node-negative breast cancer in whom the risk of recurrence is sufficiently low that adjuvant chemotherapy can be avoided.