Prediction of supraclavicular lymph node metastasis in breast carcinoma
Prediction of supraclavicular lymph node metastasis in breast carcinoma
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DOI：
10.1016/s0360-3016(01)02680-3
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发表时间：
2002-03-01
影响因子：
7
通讯作者：
Leung, WM
中科院分区：
文献类型：
--
作者：
Chen, SC;Chen, MF;Leung, WM
目的：乳腺癌患者锁骨上淋巴结转移预后较差，侵袭性局部治疗常导致严重并发症。本研究的目的是选择高危的颈转移患者进行预防性放射治疗。方法：1990年至1998年，2658例浸润性乳腺癌患者在该院接受手术和辅助治疗。中位年龄为47岁(22-92岁)。中位随访期39个月。分析年龄、肿瘤大小、肿瘤部位、组织学类型、组织学分级、雌孕激素受体状态、DNA流式细胞仪检测结果、腋窝淋巴结阳性数、化疗、放疗和/或激素治疗的使用情况、腋窝淋巴结侵犯程度等因素。结果：2658例患者中，113例(4.3%)发生锁骨上淋巴结转移。在单因素分析中，年龄较小(小于或等于40岁)、肿瘤大小<3 cm、高组织学分级、血管淋巴侵犯、雌激素受体阴性、合成时相比例>4%、阳性结节数、II或III级受累结节均为预测颈转移的有意义因素。经多因素分析，有3个预测因素有显著意义：组织学分级高，4个阳性结节，腋窝II或III级受累。腋窝I级受累且小于或等于4个阳性结节的患者，其发生率为4.4%。若累及腋窝III级，则锁骨上淋巴结转移率为15.1%。结论：>；4阳性组和腋窝II、III级受累淋巴结组锁骨上淋巴结转移率较高。对于这些高危患者，有选择地使用综合放射治疗将达到良好的局部区域控制。(C)2002年爱思唯尔科学公司。
Purpose: Supraclavicular lymph node metastasis in breast cancer patients has a poor prognosis, and aggressive local treatment has usually resulted in severe morbidity. The purpose of this study was to select high-risk neck metastasis patients for prophylactic radiotherapy.Methods: Between 1990 and 1998, 2658 consecutive invasive breast cancer patients underwent surgery and adjuvant therapy in the hospital. The median age was 47 years (range 22-92). The median follow-up period was 39 months. The following factors were analyzed: age, tumor size, tumor location, histologic type, histologic grade, estrogen and progesterone receptor status, DNA flow cytometry study results, number of positive axillary lymph nodes, use of chemotherapy, radiotherapy, and/or hormonal therapy, and level of involved axillary nodes.Results: Of the 2658 patients, 113 (4.3%) developed supraclavicular lymph node metastasis during this period. Young age (less than or equal to40 years), tumor size >3 cm, high histologic grade, angiolymphatic invasion, negative estrogen receptor status, synthetic phase fraction >4%, >4 positive nodes, and level II or III involved nodes were all significant for predicting neck metastasis in the univariate analysis. Three predictive factors were significant after multivariate analysis: high histologic grade, >4 positive nodes, and axillary level II or III involved nodes. In patients with axillary level I involved nodes and less than or equal to4 positive nodes, the incidence was 4.4%. If axillary level III was involved, the rate of supraclavicular lymph node metastasis was 15.1 %.Conclusion: The incidence of supraclavicular lymph node metastasis was higher in the groups with >4 positive nodes and in those with axillary level II or III involved nodes. Selective use of comprehensive radiotherapy for these high-risk patients will achieve good locoregional control. (C) 2002 Elsevier Science Inc.