肿瘤浸润淋巴细胞在cT1N0M0期乳腺癌淋巴结转移中的预测价值

 目的 探讨cT1N0M0期乳腺癌患者肿瘤浸润淋巴细胞（tumor-infiltrating lymphocyte,TIL）与淋巴结转移的相关性, 以及TIL密度在预测患者前哨淋巴结转移 （sentinel lymph node metastasis,SLNM） 中的价值。方法 回顾性分析2008年1月至 2016年12月于本院接受手术治疗的cT1N0M0 期乳腺癌患者的临床资料。术前在活检标本中进行 TIL 密度的组织病理学评估。采用多因素logistic回归以及受试者工作特征（ROC）曲线分析TIL预测SLNM的价值。结果  共153例cT1N0M0期乳腺癌患者纳入分析, 其中30例（19.6%）患者发生SLNM。TIL密度与雌激素受体（ER）状态（P<0.001）、孕激素受体（PgR）状态（P=0.003）、人表皮生长因子受体2（HER2）状态（P=0.029）、Ki67表达（P=0.025）、核分级（P=0.026）相关。多因素logistic回归显示, TIL密度（OR=1.40,95%CI：1.15~1.71,P=0.001）是影响cT1N0M0期乳腺癌SLNM的独立因素, 其ROC曲线下面积（AUC）为0.755 （95%CI：0.680~0.830,P<0.001）。结论 TIL密度与cT1N0M0期乳腺癌SLNM密切相关, 可能是SLNM潜在的预测指标。     

The sentinel lymph node in T1N0 breast cancer

The authors report their experience gathered from December 1998 to December 1999 in the use of the sentinel lymph node (SN) method in breast cancer treatment. In 20 out of 21 cases (95%) localization of the SN was obtained by scintigraphy while in 19 cases (90.5%) the SN was found during surgery. Histological examination of the axillary lymph nodes gave a 95% accuracy with only one negative SN associated with positive axillary lymph nodes out of a total of 19. However, the authors have subjected all patients to a complete three-level axillary dissection since they believe the method applied has not yet been fully validated.     

Predicting aggressive outcome in T1N0M0 breast cancer

Despite the excellent overall prognosis, unpredictable breast cancer recurrences and deaths also occur among T1N0M0 patients. We have evaluated clinically applicable methods for identifying aggressive outcome in T1N0M0 breast cancer. The material is based on aggressive T1N0M0 invasive ductal and lobular carcinomas diagnosed in Turku University Hospital and Jyv?skyl? Central Hospital, Finland, during 1987-1997. We studied all the T1N0M0 breast cancers that had led to recurrency or death (n=21, 95% T1cN0M0) during the follow-up period (4-14 years). The study is based on statistical analyses of matched case-control data in which the prognostic factors of each individual patient with aggressive disease were compared with control patients (n=45) individually matched by tumour size, age at diagnosis, histological type of tumour and length of follow-up. The cancer cases were examined for clinically applicable conventional and immunohistochemical pathologic prognostic factors. High Ki-67 immunopositivity was the strongest prognosticator of breast cancer death or recurrence in T1N0M0 breast cancer. Also, high p53 immunopositivity, low oestrogen receptor immunopositivity and Her-2/neu oncogene amplification by chromogen in situ hybridisation were reliable indicators of unfavourable outcome. Our statistical methods also allowed us to determine for the present material a range of clinical significance for each immunohistochemical prognostic feature with the associated relative risk for breast cancer death and recurrence. The paper suggests guidelines for predicting aggressive outcome in T1N0M0 breast cancer.     

Axillary dissection versus no axillary dissection in older T1N0 breast cancer patients: 15-Year results of trial and out-trial patients

Background

Our randomized trial found no survival advantage for axillary dissection (AD) compared observation only (no AD) in older patients with early breast cancer and a clinically negative axilla, indicating that AD is unnecessary. We compared characteristics and outcomes in out-trial patients with those in trial patients to provide indications as to whether AD can be safely omitted outside the trial setting.

Methods

The trial started in 1996, recruiting 238 patients age 65–80 years with cT1cN0 breast cancer, randomized to conservative surgery with or without AD. Over the recruitment period, 109 eligible patients who refused to participate in the trial, also received conservative breast surgery with or without AD depending on patient preference/surgeon opinion. Trial and out-trial patients received conventionally-fractioned whole breast radiation and tamoxifen for five years. Endpoints were breast cancer mortality, overall survival, and cumulative incidence of axillary disease in patients not receiving AD.

Results

After 15 years of follow-up, breast cancer mortality and overall survival did not differ between the AD and no AD arms, in either the trial or out-trial cohorts. The 15-year cumulative incidence of axillary relapse was 6% in the no AD arm of the trial group, and zero in the no AD arm of the out-trial group.

Conclusions

Outside the trial setting, older patients with T1N0 breast cancer can be safely treated by conservative surgery, postoperative radiotherapy and tamoxifen for five years (if ER-positive). Axillary surgery is appropriate only for the small proportion of patients who develop overt axillary disease during follow-up.     

Adjuvant BCG immunotherapy for breast cancer (T1N0M0, T2N0M0)

The present study was performed to evaluate the effect of BCG immunotherapy for breast cancer (T1n0M0, T2n0M0) in nonrandomized series. During a 5-year follow-up study, patients in the BCG-treated group suffered neither recurrence nor death, while the historical control group had 6 cases of recurrence and 5 cases of disease death. As seen in our series, we concluded that breast cancer patients should be advised to accept adjuvant BCG immunotherapy after mastectomy.     

T1N0M0乳腺癌临床病理特征和预后分析

目的：探讨T1N0M0乳腺癌患者的临床病理特征与预后关系。方法：收集2003-01-01-200912-31广东省妇幼保健院乳腺病防治中心住院治疗的137例T1N0M0乳腺癌患者的资料,回顾性分析临床病理特征与预后的关系。结果：共收治934例I～ⅢA期乳腺癌患者,其中T1N0M0乳腺癌137例,占14．7％。137例T1N0M0乳腺癌患者中有33例（24．1％）为T1mic,42例（30．7％）为T1a～T1b,62例（45．2％）为T1c。肿瘤大小与组织学分级（P=0．001）有关,与年龄（P=0．526）、ER／PR（P=0．371）、HER-2（P=0．624）、手术方式（P=0．479）和术后辅助化疗（P=0．066）无明显相关性。中位随访47个月,5例患者复发转移,其中1例患者死于肝转移,5年无病生存期（disease-freesurvival,DFS）为96．4％,5年总生存期（overallsurvival,OS）为99．3％。在单因素分析中,T1N0M0乳腺癌的5年DFS与肿瘤组织学分级（P=0．010）和ER／PR状态（P=0．043）有关,而与年龄（P=0．217）、肿瘤大小（P=0．880）、HER-2状态（P=0．769）、手术方式（P=0．477）和有无化疗（P=0．560）无关;在多因素分析中,仅肿瘤组织学分级是5年DFS的独立影响因素,P=0．045。组织学分级G1、G2和G3患者的5年DFS分别为100．0％、96．3％和84．2％,伴有组织学分级非G3患者的5年DFS（98．3％）优于伴有组织学分级G3（84．2％）的患者,P=0．005;G2（96．3％）和G1（100．0％）患者5年DFS差异无统计学意义,P=0．109。结论：肿瘤组织学分级是T1N0M0乳腺癌的5年DFS独立影响因素,肿瘤组织学分级高的患者预后差。肿瘤组织学分级可为T1N0M0乳腺癌的辅助化疗决策提供参考依据。     

Prognostic significance of molecular subtype in T1N0M0 breast cancer: Korean experience

Purpose

Gene expression profiling studies have identified several breast cancer subtypes associated with markedly different clinical outcomes. In general, patients with stage I breast cancer have excellent outcomes. We assessed the clinicopathological characteristics and outcomes of patients with T1N0M0 breast cancer according to molecular subtype.

Methods

Seven hundred and sixty-two T1N0M0 breast cancer patients undergoing curative surgery between January 1990 and December 2007 were analyzed. Subtypes were classified according to hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status as follows: HR+/HER2−, HR+/HER2+, HR−/HER2− (triple-negative, TN), and HR−/HER2+.

Results

The distribution of subtypes was HR+/HER2−, 56.6%; HR+/HER2+, 10.1%; TN, 20.1%; and HR−/HER2+, 13.3%. Marked differences were observed among subtypes in multifocality/multicentricity, histological grade, extensive intraductal components, p53 expression and the Ki-67 index. There were differences in recurrence-free survival and overall survival among patients with different molecular subtypes (log-rank p < 0.001 and 0.024, respectively). By multivariate analysis, lymphovascular invasion and classification of molecular subtype were independent predictors of recurrence (p = 0.003 and 0.043, respectively). The TN subtype showed significantly worse recurrence-free survival compared to the HR+/HER2− subtype (hazard ratio, 4.54; 95% confidence interval, 1.60-12.86; p = 0.004).

Conclusion

Patients with T1N0M0 breast cancer, a group with generally favorable clinical outcomes, had prognoses that were associated with the molecular subtype. The TN subtype was an independent predictor for recurrence in patients with T1N0M0 breast cancer.     

Axillary dissection in breast cancer revisited

The pathological status of the axillary nodes remains the single most determining factor for survival, local recurrence and disease-free interval in operable breast cancer. Radical axillary dissection results in better local control with or without systemic disease in all operable cases. In pathologically negative cases, radical axillary dissection decreases local recurrence rates and perhaps prolongs disease-free survival. In pathologically positive cases, radical axillary dissection improves local control only. Radical axillary dissection avoids axillary irradiation and so decreases the risk and the importance of lymphoedema. Perfect axillary dissection does not show a decisive advantage over less complete axillary dissection when the 'quality' of surgery is measured by lymphoscintigraphy, but it should be kept in mind that only total control of the local situation can ensure a patient free of distal spread at the time of first therapy.     

Axillary lymph node metastasis in lung cancer

Study objectives Axillary lymph node metastasis (ALNM) from lung cancer is rare. Its prognosis and effective treatments remain unknown. To evaluate clinicopatholgical characteristics of such lung cancer patients, we performed a retrospective study of them, who had ALNM at the time of initial presentation or developed ALNM in their clinical courses. Methods We reviewed the medical records and pathological reports of all patients at our division who had a diagnosis of primary lung cancer from January 1985 through August 2007. Results Ten (0.75%) of 1,340 patients had ALNM. In eight of them, ALNM was detected at the time of initial diagnosis, and two patients developed ALNM in their clinical courses. Lymphatic metastasis to mediastinum was evident in all patients. Supraclavicular and cervical lymph nodes were involved in five and three patients, respectively. One patient had direct chest wall invasion from the lung. Three patients had distant metastases other than axillary or cervical lymph nodes. Four patients received systemic chemotherapy, and another four patients received palliative chest irradiation or supportive care because of their poor performance status. Median survival time of 8 patients who were diagnosed as having ALNMs at initial presentation was 7 months. Conclusions The most likely mechanism for axillary node involvement is intercostal lymphatics via spread from mediastinal lymph node metastasis. Routine palpation of the axillae is recommended if chest wall invasion, mediastinal and/or supraclavicular lymph nodes are found either at initial presentation or at follow-up of patients.     

T1micN0M0、T1aN0M0和T1bN0M0乳腺癌376例临床特征和预后分析

目的:分析T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者的临床病理学特征,了解其生存状态,探讨与预后相关的独立影响因素。方法:收集2002年1月—2005年12月4487例可手术的乳腺癌患者的临床病理学资料,回顾性分析其中376例T1micN0M0、T1aN0M0和T1bN0M0患者的临床病理学特征、复发和转移以及生存情况。结果:376例患者中,66例(17.6%)为T1mic(pT≤0.1cm),122例(32.4%)为T1a(0.1cm相似文献   

Axillary lymphocele after axillary dissection or sampling of sentinel lymph node in breast cancer

The goal of this study was to evaluate the rate of seromas after axillary dissection or sentinel lymph node biopsy. This is a prospective study based upon a series of 229 patients. Among those 229 patients, 179 had an axillary dissection and 50 had a sentinel lymph node biopsy. In the axillary dissection group, 40% of patients developed a seroma. The maximum number of aspirations needed was 8. In the sentinel lymph node group, 18% of patients developed a seroma that never recurred after a single aspiration. Seromas are still a very frequent complication after axillary dissection. The sentinel lymph node biopsy has helped to reduce the rate of axillary seroma, and the number of aspirations needed to evacuate them.     

Prognostic assessment of PTK activity in T1-T2, N0-N1, M0 breast cancer: a multicentric retrospective study

Protein tyrosine kinases (PTKs) play a major role in the transduction of intracellular mitogenic signal. PTKs are also involved in the process of cellular transformation. A number of studies have reported increased PTK activities in cytosolic fractions from human breast carcinoma. However, the possible pronostic value of these activities is difficult to establish from these studies, mostly conducted on limited numbers of patients. In order to clear up the issue, we have investigated a large series of patients with a long follow-up, using a retrospective multicentric study (894 breast cancers T1-T2, N0-N1, M0; median follow-up: 67 months). PTKs were measured using a radioenzymatic assay as described in our previously report. We confirmed the already observed correlation between PTK activities and Scarff–Bloom grading (p > 10^–5), negative estrogen receptor (ER), and progesterone receptor (PR) status. By contrast, we found in this study a correlation between PTK values and clinical nodal status (p = 0.00027) not showed in our precedent analysis. In Cox multivariate analysis, PTK activity does not emerge as a significant pronostic parameter. On the other hand, tumor PTK activity assay may prove of great interest in clinical research using newly developed tyrosine kinase inhibitors in order to assess their biological impact and eventually to predict the responsiveness to these new therapeutic agents.     

Conservative surgery for T2 > 3 cm, T3 N0 N1 M0 breast cancer after induction chemotherapy

Induction chemotherapy (IC) provides in more than 20% of cases a complete shrinkage of the tumor. This down staging is a new challenge for the surgeons for breast conservative procedure. Although, IC has become the standard of care for breast cancer T2 > 3 cm T3 N0 N1 M0. No guidelines have devoted attention to the surgical problems due to this down staging after IC. Location and size of the tumor before IC have to be studied and outlined by the surgeon himself. During surgery, the residual tumor volume and how much mammary gland must be removed are very difficult to determine. The maximum volume of mammary gland to be removed after IC around the primary site of the tumor before IC is the volume which permits a good cosmetic reconstruction of the breast. After IC, in spite of an important downstaging, an axillary clearance must be done. For N0 patients, sentinel lymph node biopsy could be performed before IC. If the sentinel node is p N0, axillary clearance could be avoided.     

Axillary metastasis in clinically node-negative breast cancer

Aim of work

This study investigates the factors related to metastasis detection in a sentinel lymph node biopsy (SLN) in patients without clinical axillary involvement.

A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma

This study was undertaken to investigate the long-term survival and the probability of "cure" in a group of 644 patients treated by mastectomy for T1 breast carcinoma. After a median follow-up of 18.2 years, 23% were dead of recurrent breast carcinoma, 3% were alive with recurrent disease, and 74% had not experienced a recurrence. The probability of recurrence was directly related to the initial extent of the disease. Overall, 16% of recurrences and 25% of deaths due to disease occurred in the second decade of follow-up. The proportion of recurrences detected in the second decade was inversely related to the stage of the primary tumor at diagnosis. When stratified by tumor size, T1N0M0 patients with tumors 1.0 cm or less in diameter had a significantly better 20-year recurrence-free survival (86%) than did T1N0M0 patients with tumors 1.1 to 2.0 cm (69%). When observed and expected survival curves were compared by the method of Brinkley and Haybittle, it appeared that 80% of T1N0M0 patients with tumors 1 cm or less might be cured at 20 years, whereas for those in the 1.1- to 2-cm group, the proportion cured was indeterminate, but might be as high as 70%. A potentially cured group could not be identified among T1N1M0 patients, but an estimated 52% of these patients did not have a recurrence within the nearly 20-year follow-up period. These data are important when one considers the proper role of adjuvant therapy for stage I disease. Patients with tumors larger than 1 cm and those with axillary lymph node metastases may have an improved recurrence-free survival as a result of systemic adjuvant treatment, while women in the T1N0M0 group with an especially favorable recurrence-free survival, particularly those with tumors 1 cm in diameter or smaller, might be spared adjuvant therapy.     

Axillary recurrence in women with a negative sentinel lymph node and no axillary dissection in breast cancer

OBJECTIVES: Sentinel lymph node biopsy (SLNB) is widely used for staging breast cancer. SLNB accurately determines axillary lymph node status with a low false negative rate. There remains concern that omitting axillary dissection may lead to recurrence in the axilla, and impact long term survival. The purpose of this study was to determine the frequency of axillary lymph node recurrence in patients who had a negative sentinel lymph node and did not undergo axillary node dissection. METHODS: Data was collected on all patients who had negative SLNB at Roswell Park Cancer Institute between July 1997 and June 2002. Demographics, type of operation, postoperative systemic, and radiation therapy, co-morbidity score, hormone receptor status, and the pathologic features of the tumor were abstracted for each patient. For each woman with recurrence, the dates of recurrence, the site(s) of recurrence, and the treatment for recurrence were recorded. RESULTS: With a median follow-up of 33 months, 15 of 335 (4.5%) women who had negative SLNBs and who did not undergo completion axillary dissection developed a cancer recurrence. Only two patients (0.6%) had an axillary recurrence. CONCLUSIONS: The rate of axillary recurrence following a negative sentinel node biopsy is the same or less than axillary lymph node dissection (ALND) alone. Concerns that omitting completion axillary dissection following a negative SLNB will increase the rate of axillary recurrence appear unfounded.     

T1-2N1M0早期乳腺癌术后放射治疗的研究进展

乳腺癌是危害女性健康的常见疾病,术后放疗(PMRT)可以提高患者生存率,减少乳腺癌转移及复发率,是治疗乳腺癌的重要方法.术后放疗对1～3个淋巴结阳性乳腺癌的治疗效果及预后影响仍是当前的讨论热点.本文就高危因素、分子分型、21基因检测、预后营养指数等对T1-2 N1 M0早期乳腺癌术后放疗的指导意义作一综述.     

Late mortality from pT1N0M0 breast carcinoma.

BACKGROUND: pT1N0M0 breast carcinoma (< or = 2 cm in greatest dimension, lymph node negative) is associated with generally favorable 5-year and 10-year survival, but to the authors' knowledge there are few data available regarding the long term outcome of these patients. METHODS: The authors identified women with breast carcinoma diagnosed between 1945-1984 in a geographically defined urban population using the files of the Finnish Cancer Registry and local hospital records (n = 1495). The clinical and autopsy records and histologic slides were reviewed. The series contained 265 patients with unilateral pT1N0M0 breast carcinoma treated with mastectomy and axillary lymph node dissection without adjuvant systemic therapy and who were followed for 10-44 years (median, 17 years) after the initial diagnosis or until death. RESULTS: The last death from pT1N0M0 breast carcinoma occurred 23 years after the initial diagnosis. The 20-year overall survival rate was 54% (95% confidence interval [95% CI], 48-60%) and the survival rate when corrected for intercurrent deaths was 81% (95% CI, 75-87%). The 20-year survival rate when corrected for intercurrent deaths was 92% (95% CI, 86-98%) in patients with T1a-b disease (primary tumor < or = 10 mm), but was only 75% (95% CI, 64-86%) in patients with pTc disease (range, 11-20 mm). None of the patients with well differentiated (World Health Organization Grade 1) pTa-b tumors died of breast carcinoma (n = 48) whereas the 20-year survival rate when corrected for intercurrent deaths was 81% (95% CI, 67-95%) in patients with Grade 2-3, pT1a-b tumors (P = 0.002). CONCLUSIONS: Patients with well differentiated pT1a-b tumors form a subgroup with excellent long term prognosis, but a significant proportion of women with either moderately or poorly differentiated pT1a-b tumors or pT1c tumors ultimately die of the disease.