Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up.
Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up.
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淋巴血管侵袭和肿瘤外肿瘤扩展是乳腺癌相关的淋巴水肿的风险指标：一项长期随访的观察性回顾性研究。
DOI：
10.1186/s12885-018-4851-2
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发表时间：
2018-09-29
期刊：
影响因子：
3.8
通讯作者：
Fusco N
中科院分区：
文献类型：
--
作者：
Invernizzi M;Corti C;Lopez G;Michelotti A;Despini L;Gambini D;Lorenzini D;Guerini-Rocco E;Maggi S;Noale M;Fusco N
乳腺癌相关淋巴水肿（BCRL）发生在相当大比例的乳腺癌幸存者中，是患者残疾的主要原因。遗憾的是，目前还没有有效的预测生物标志物、诊断工具和强有力的证据支持的BCRL治疗策略。在这里，我们提供了一个综合性的一系列妇女淋巴结阳性乳腺癌的特点，并确定新的真正的预测BCRL发生。回顾性收集了332例接受过外科治疗的淋巴结阳性乳腺癌病例（随访2-10.2年）。其中62例发生BCRL。为了确定与BCRL相关的人口统计学和临床病理学特征，对分类变量进行Fisher精确检验或卡方检验;对连续变量采用Wilcoxon秩和。使用考克斯比例风险回归模型评估与BCRL发生相关的因素。腋窝淋巴结的整体切除而不是乳房手术类型会影响BCRL的发育。大多数BCRL患者有管腔A样肿瘤。与对照组相比，BCRL中转移性沉积物累及的淋巴结中位数显著更高（p = 0.04）。肿瘤周围淋巴管浸润（LVI）和淋巴结转移（ENE）对无BCRL生存率有负面影响（p = 0.01）。具体而言，与ENE阴性患者相比，LVI和左侧定位患者发生BCRL的风险高4倍，而ENE右腋淋巴结转移增加了BCRL的概率。LVI和ENE的评估应与临床和手术数据相结合，以改善BCRL风险分层。本文的在线版本（10.1186/s12885-018-4851-2）包含补充材料，可供授权用户使用。
Breast cancer related lymphoedema (BCRL) occurs in a substantial proportion of breast cancer survivors and is a major contributor to patients’ disability. Regrettably, there are no validated predictive biomarkers, diagnostic tools, and strong evidence-supported therapeutic strategies for BCRL. Here, we provide an integrative characterization of a large series of women with node-positive breast cancers and identify new bona fide predictors of BCRL occurrence. Three hundred thirty-two cases of surgically-treated node-positive breast cancers were retrospectively collected (2–10.2 years of follow-up). Among them, 62 patients developed BCRL. To identify demographic and clinicopathologic features related to BCRL, Fisher’s exact test or Chi-squared test were carried out for categorical variables; the Wilcoxon rank-sum was employed for continuous variables. Factors associated with BCRL occurrence were assessed using a Cox proportional hazards regression model. En-bloc dissection of the axillary lymph nodes but not the type of breast surgery impacted on BCRL development. Most of BCRL patients had a Luminal A-like neoplasm. The median number of lymph nodes involved by metastatic deposits was significantly higher in BCRL compared to the control group (p = 0.04). Both peritumoral lymphovascular invasion (LVI) and extranodal extension (ENE) of the metastasis had a negative impact on BCRL-free survival (p = 0.01). Specifically, patients with LVI and left side localization harboured 4-fold higher risk of developing BCRL, while right axillary nodes metastases with ENE increased the probability of BCRL compared to ENE-negative patients. Assessment of LVI and ENE should be integrated with clinical and surgical data to improve BCRL risk stratification. The online version of this article (10.1186/s12885-018-4851-2) contains supplementary material, which is available to authorized users.