The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes
The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes
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DOI：
10.1002/cncr.20969
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发表时间：
2005-05-15
期刊：
影响因子：
6.2
通讯作者：
Olivotto, IA
中科院分区：
文献类型：
--
作者：
Truong, PT;Berthelet, E;Olivotto, IA
背景。由于报告的基线局部区域复发 (LRR) 风险存在差异，对 T1-T2 乳腺癌和 1-3 个淋巴结阳性的女性进行辅助治疗存在争议。这种不一致归因于淋巴结分期技术的差异，这些技术产生了不同数量的解剖淋巴结。当前的研究评估了阳性/解剖淋巴结的百分比对具有一到三个阳性淋巴结的女性的复发和生存的预后影响。该研究队列由 542 名患有病理性 T1-T2 乳腺癌的女性组成，她们有 1-3 个阳性淋巴结，接受了乳房切除术并接受了辅助全身治疗，但没有放疗。使用不同的截止水平检查按阳性淋巴结数量、解剖淋巴结数量和阳性淋巴结百分比分层的十年 Kaplan-Meier (KM) LRR、远处复发 (DR) 和总生存 (OS) 率。进行多变量分析以评估阳性淋巴结百分比在疾病复发和生存中的预后意义。结果。中位随访时间为 7.5 年。 LRR、DR 和 OS 率与阳性淋巴结数量和阳性淋巴结百分比显着相关，但与解剖淋巴结数量无关。观察到 LRR 最显着差异的截止水平是 25% 阳性淋巴结（阳性淋巴结≤ 25% 和≥25% 的女性，10 年 KM LRR 率分别为 13.9% 和 36.7%；P < 0.0001）。在≥GT 的患者中观察到较高的 DR 率和较低的 OS 率。淋巴结阳性率 25% 的患者与淋巴结阳性率≤ 25% 的患者相比（DR：分别为 53.0% vs. 30.3%；P < 0.0001；OS：分别为 43.4% vs. 62.6%；P < 0.0001）。在多变量分析中，阳性淋巴结的百分比和组织学分级是与 LRR、DR 和 OS 相关的显着独立因素。结论。 >的存在;对于有 1-3 个阳性淋巴结的患者，25% 的淋巴结阳性是一个不良预后因素，可用于识别乳房切除术后局部和远处复发高风险的患者，这些患者可能受益于辅助放疗和更积极的全身治疗方案。 © 2005 美国癌症协会。
BACKGROUND. Adjuvant therapy for women with T1-T2 breast carcinoma and 1-3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODS. The study cohort was comprised of 542 women with pathologic T1-T2 breast carcinoma who had 1-3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten-year Kaplan-Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut-off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTS. The median follow-up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut-off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10-year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONS. The presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1-3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. © 2005 American Cancer Society.