Breast Cancer-Specific Mortality in Small-Sized Tumor with Stage IV Breast Cancer.
Breast Cancer-Specific Mortality in Small-Sized Tumor with Stage IV Breast Cancer.
复制标题
IV 期乳腺癌小尺寸肿瘤的乳腺癌特异性死亡率。
作者：
Zheng YZ;Wang XM;Fan L;Shao ZM
背景原发性肿瘤小并不意味着预后好。我们假设，非常小的原发性乳腺肿瘤与广泛的淋巴结（LN）转移代表了积极的生物学行为，在第四阶段diseases.Materials和MethodsData之间的2010年和2015年回顾性检索从监测，流行病学，和最终结果数据库与女性性别，单侧，转移性，T1/2浸润性导管癌的纳入标准。主要研究变量包括T分期、N分期、分级、转移部位、受累部位数量、雌激素受体状态、孕激素受体状态和人表皮生长因子受体2状态。使用Kaplan-Meier和校正的考克斯比例风险模型（含相互作用项）。根据肿瘤大小检查1年、2年和3年乳腺癌特异性死亡率（BCSM）。ResultsWe确定了5,340例符合条件的乳腺癌患者。在多变量分析中，发现种族、年龄、分级、分子亚型、手术、脑转移和肝转移与BCSM独立相关。对于T1肿瘤，N 0、N1和N2+组具有相同的BCSM。在小于50 mm的肿瘤中，1年、2年和3年BCSM未随肿瘤大小的减小而降低。对于三阴性乳腺癌（TNBC），T1 a/T1 bN 2+组的BCSM显著差于任何其他group.ConclusionPatients与IV期癌症与小尺寸肿瘤的BCSM可能与那些较大的肿瘤一样高。在TNBC中，具有严重LN累及的非常小的肿瘤与最差的BCSM相关。需要继续努力进一步研究Ta 1/T1 bN 2 + M1 TNBC，并为受影响的患者提供个性化治疗。实践意义这项研究显示，对于IV期乳腺癌，较小的原发肿瘤并不总是与较好的乳腺癌特异性死亡率相关。这项研究表明，具有广泛区域淋巴结受累的非常小的三阴性乳腺癌（TNBC）可能是生物学侵袭性疾病的替代品。由于T1 a/T1 bN 2 + TNBC预后不良，可能迫切需要对受影响的患者进行更个性化的治疗。未来的相关研究应关注Ta 1/T1 bN 2 + TNBC的遗传和分子差异对生物学行为的影响。阐明在淋巴结和远端部位具有转移性生长的非常小的原发性TNBC的调节机制将在开发靶向治疗中发挥不可或缺的作用。
BackgroundSmall‐sized primary tumor does not always indicate a better prognosis. We hypothesized that very small primary breast tumors with extensive lymph node (LN) metastases represented an aggressive biologic behavior in stage IV disease.Materials and MethodsData between 2010 and 2015 were retrieved retrospectively from the Surveillance, Epidemiology, and End Results database with inclusion criteria of female sex, unilateral, metastatic, and T1/2 invasive ductal carcinoma. Primary study variables included T stage, N stage, grade, metastatic sites, number of involved sites, estrogen receptor status, progesterone receptor status, and human epidermal growth factor receptor 2 status. Kaplan‐Meier and adjusted Cox proportional hazards models with interaction terms were used. One‐, 2‐ and 3‐year breast cancer‐specific mortality (BCSM) was examined according to tumor size.ResultsWe identified 5,340 eligible patients with breast cancer. In multivariate analysis, race, age, grade, molecular subtype, surgery, brain metastases, and liver metastases were found to be independently associated with BCSM. For T1 tumors, the N0, N1, and N2+ groups had the same BCSM. In tumors smaller than 50 mm, the 1‐, 2‐, and 3‐year BCSM did not decline with the decrease of tumor size. For triple‐negative breast cancers (TNBCs), the T1a/T1bN2+ group had significantly worse BCSM than any other group did.ConclusionPatients with stage IV cancer with small‐sized tumors may have BCSM as high as those with larger tumors. In TNBCs, very small tumors with severe LN involvement are associated with the worst BCSM. Continued efforts are needed to further investigate Ta1/T1bN2 + M1 TNBCs and individualize the treatment for affected patients.Implications for PracticeThis study revealed that for stage IV breast cancer, smaller primary tumors were not always associated with better breast cancer‐specific mortality. This study illustrated that very small triple‐negative breast cancers (TNBCs) with extensive regional lymph node involvement may be a surrogate for biologically aggressive disease. Because of poor prognosis of T1a/T1bN2+ TNBCs, there might be an urgent need of more individualized treatment for affected patients. Future correlative studies ought to focus on the genetic and molecular differences in Ta1/T1bN2+ TNBCs that contribute to the biological behavior. Clarification of the regulation mechanism of very small‐sized primary TNBCs with metastatic outgrowth in nodes and distant sites will play an integral role in developing targeted therapies.