A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy.
A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy.
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DOI：
10.3892/or.2016.4635
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发表时间：
2016-05
期刊：
影响因子：
4.2
通讯作者：
Kijima H
中科院分区：
文献类型：
--
作者：
Morohashi S;Yoshizawa T;Seino H;Hirai H;Haga T;Ota R;Wu Y;Yoshida E;Hakamada K;Kijima H
新辅助化疗（NAC）的适应症最近已扩大到包括其在早期乳腺癌治疗中的应用。乳腺癌NAC后腋窝淋巴结转移是一个不良预后因素。因此，预测淋巴结转移对评估乳腺癌NAC术后患者的预后具有重要意义。因此，我们将重点研究NAC后乳腺原发肿瘤的残留癌型，并探讨其与淋巴结转移的关系。在这项研究中，我们检查了50例乳腺癌标本和相关的NAC后淋巴结清扫。我们将40例乳腺原发肿瘤分为根除淋巴结组和残留淋巴结组，分析其残留癌类型。根据癌细胞的细胞密度将残余癌类型分为致密型、局灶型/巢型和散发性/原位型。三种模式组间残留癌型差异均有统计学意义（P<0.01）。残余淋巴结组致密型发生率高，根除淋巴结组散发性/原位型发生率高。对乳腺原发肿瘤残余癌型及临床病理因素的分析显示，致密组与非致密组在CT上肿瘤缩小率（P<0.001）、NAC前原发肿瘤面积（P<0.01）、NAC后原发肿瘤面积（P<0.00001）、内在亚型（P<0.01）、Ki-67标记指数（P<0.01）、组织学分级（P<0.05）、有丝分裂计数（P<0.01）等方面差异均有统计学意义。因此，我们的研究结果表明，残留癌类型有助于预测NAC后乳腺癌的淋巴结清除或残留以及恶性潜能。
The indication for neoadjuvant chemotherapy (NAC) has recently broadened to include its use in the treatment of initial stage breast cancer. Axillary lymph node metastasis after NAC in breast cancer is a poor prognostic factor. Thus, the prediction of lymph node metastasis is important to estimate the prognosis of breast cancer patients after NAC. Therefore, we focused on residual carcinoma patterns of primary breast tumors after NAC and examined the correlation between the patterns and lymph node metastasis. In this study, we examined 50 breast cancer specimens and associated dissected lymph nodes after NAC. We divided 40 cases into an eradicated lymph node group and a residual lymph node group to analyze residual carcinoma patterns of primary breast tumors. Residual carcinoma patterns were classified according to the cell density of carcinoma cells: dense, focal/nested and sporadic/in-situ. There were significant differences in residual carcinoma patterns (P<0.01) among the three pattern groups. There was a high incidence of dense patterns in the residual lymph node group and a high incidence of sporadic/in-situ patterns in the eradicated lymph node group. Analysis of residual carcinoma patterns of primary breast tumors and clinicopathological factors demonstrated that there were significant differences in tumor reduced ratio on CT (P<0.001), primary tumor area before NAC (P<0.01), primary tumor area after NAC (P<0.00001), intrinsic subtype (P<0.01), Ki-67 labeling index (P<0.01), histological grade (P<0.05) and mitotic count (P<0.01) between the dense and non-dense groups. Therefore, our results suggest that the residual carcinoma pattern is useful for predicting eradicated or residual lymph nodes and the malignant potential in breast cancer after NAC.