腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响

目的 探讨腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响。方法 选取75例初次保乳手术后复发乳腺癌患者作为研究对象，依据术前腋窝淋巴结状态分为阳性组(32例)及阴性组(43例)。所有患者均行保乳手术+腋窝淋巴结清扫术治疗，比较两组局部区域复发情况、临床病理特征，并分析远处转移、生存情况及复发的影响因素。结果 两组局部复发、区域复发及局部+区域复发率相比，差异无统计学意义(P>0.05);75例患者共45例发生远处转移(60.00%),阳性组远处转移率为78.13%(25/32),高于阴性组的46.51%(20/43),有统计学差异(P<0.05);生存分析显示，复发后3年生存率为57.33%(43/75),复发后5年生存率为38.67%(29/75);阳性组复发后总生存率较阴性组低，有统计学差异(P<0.05);多因素分析显示：复发部位、腋窝淋巴结状态为复发患者总生存的独立影响因素(P<0.05)。结论 腋窝淋巴结转移可影响初次保乳手术乳腺癌患者预后，能降低术后生存率，缩短患者总生存时间，增加复发后远处转移风险。     

早期乳腺癌患者预后因素分析

目的:研究T1～T2、0～3枚阳性淋巴结乳腺癌患者肿瘤复发和生存的预后因素.方法:回顾分析天津医科大学附属肿瘤医院收治的540例乳腺癌患者资料.进行单因素变量分析及Cox回归分析肿瘤复发和生存的预后因素.结果:>20%阳性腋窝淋巴结率是影响肿瘤局部复发的预后因素(HR=12.816,P<0.001);>20%阳性淋巴结率和浸润性导管癌是影响肿瘤远处转移的预后因素(HR=11.088,P<0.001;HR=0.390,P=0.018);1～3枚阳性淋巴结和>20%阳性淋巴结数是显著影响10年总生存率的预后因素(HR=2.110,P=0.001;HR=10.244,P<0.001),二者也是影响10 年无瘤生存率的预后因素(HR=1.634,P=0.004;HR=7.339,P<0.001).结论:腋窝淋巴结有无转移是影响10年局部复发,远处转移,总生存率和无瘤生存率的重要的预后因素.原发肿瘤组织病理是显著影响10年肿瘤远处转移的预后因素.     

腋窝淋巴结阴性年轻乳腺癌患者的远期生存分析

摘 要：［目的］ 分析腋窝淋巴结阴性年轻乳腺癌患者的远期生存和影响预后的因素。［方法］ 1997年1月至2004年12月共手术治疗101例腋窝淋巴结阴性年龄≤35岁的乳腺癌患者。通过病例记录和系列随访收集患者的临床病理资料和生存情况。生存率计算采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素预后分析采用Cox比例风险模型。［结果］ 中位随访12.18 年 (0.18~19.47年),全组共有3例患者失访,10例发生局部复发和/或区域淋巴结转移,10例远地转移（其中6例同时伴有区域复发）,11例第二原发恶性肿瘤,13例患者死亡。全组10年无病生存率、无疾病复发生存率、无远地转移生存率和生存率分别为70.0%、75.1%、83.4% 和 87.2%。淋巴结解剖个数≤10个是影响生存的因素(P=0.036)。肿瘤大小是影响疾病复发的独立因素(P=0.050),但对远地转移和生存均无影响。［结论］ 腋窝淋巴结阴性年轻乳腺癌患者的远期预后尚好,肿瘤大小和腋窝淋巴结解剖个数分别是疾病复发和生存的影响因素。     

激素受体和人表皮生长因子受体2的表达与改良根治术后淋巴结阳性乳腺癌患者预后的关系

目的 探讨雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(Her-2)的表达情况与行改良根治术后腋窝淋巴结阳性乳腺癌患者预后的关系.方法 收集835例行改良根治术后腋窝淋巴结阳性乳腺癌患者的临床和随访资料.根据ER、PR和Her-2的免疫组化检查结果,将患者分为Rec-/Her-2-(三阴性)组、Rec-/Her-2+组、Rec+/Her-2+组和Rec+/Her-2-组,比较其局部区域复发率、远处转移率、无瘤生存率和总生存率.结果 835例患者中,三阴性组141例,Rec-/Her-2+组99例,Rec+/Her-2+组157例,Rec+/Her-2-组438例.Rec+/Her-2-患者的5年局部区域复发率为6.2%,低于其他患者(12.9%,P=0.004).与受体阳性组(Rec+/Her-2+和Rec+/Her-2-)比较,受体阴性组(Rec-/Her-2-和Rec-/Her-2+)有较高的5年远处转移率(26.4%和19.7%,P=0.0008)、较低的5年无瘤生存率(66.7%和75.6%,P=0.0001)和较低的5年总生存率(71.4%和84.2%.P=0.0000).多因素Cox回归分析结果显示,激素受体和Her-2的表达状态是乳腺癌患者局部区域复发、远处转移、无瘤生存和总生存的独立影响因素(均P<0.05),Rec+/Her-2-患者的局部区域复发风险低,受体阴性患者发生远处转移和死亡的风险高.结论 ER、PR和Her-2是改良根治术后腋窝淋巴结阳性乳腺癌患者的独立预后因素.     

腋窝淋巴结1～3个转移的乳腺癌根治术后辅助放疗指征探讨

目的 回顾分析412例腋窝淋巴结1～3个转移的乳腺癌根治术后患者的预后因素,探讨术后辅助放疗的指征.方法 用Kaplan-Meier法计算生存率,用Logrank法和Cox模型分别进行单因素和多因素预后分析,分析影响局部复发和远处转移的预后因素.结果 随访率为98.7%.随访满5、10年者分别为215、41例.5、10年总生存率分别为90.0%、81.3%.无、有局部复发的5年总生存率分别为92.9%、69.9%(x2=20.79,P=0.000).5、10年局部复发±远处转移率分别为10.7%、18.6%.多因素分析显示T2期,≥2个腋窝淋巴结转移,雌、孕激素受体均阴性为影响局部复发的预后因素.含0～1、2～3个预后因素的10年局部复发率分别为3.9%、36.9%(x2=20.64,P=0.000).多因素分析显示局部复发、阳性淋巴结转移率＞25%为影响远处转移的预后因素,无、有局部复发的5年远处转移率分别为9.7%、36.6%(x2=16.34,P=0.000).结论 对腋窝淋巴结1～3个转移的乳腺癌根治术后患者且含2～3个影响局部复发的预后因素者建议行术后辅助放疗.     

乳腺癌改良根治术后复发高危患者的放疗结果和预后因素分析

目的 总结本院高危乳腺癌患者改良根治术后的治疗结果,探讨放疗的作用和照射野的选择,并对生存预后因素进行分析.方法 回顾性分析381例T_3～T_4期和(或)腋窝淋巴结转移数≥4个的改良根治术后乳腺癌患者临床资料.用Kaplan-Meier法计算生存率,并Logrank法检验.单因素分析临床病理和治疗因素对生存率的影响,多因素分析用Cox回归模型.结果 中位随访时间为48个月.总5年无局部区域复发率为89.7%、总生存率为76.8%.放疗显著提高5年无局部区域复发生存率(93.4%:77.1%,χ~2=19.95,P=0.000)和总生存率(80.9%:62.3%,χ~2=15.47,P=0.001).胸壁和锁骨上区域照射能提高患者的5年无胸壁复发生存率(96.8%:86.2%;χ~2=12.66,P=0.001)和无锁骨上淋巴结复发生存率(97.7%:90.7%,χ~2=9.98,P=0.002),腋窝照射对5年无腋窝复发生存率无影响(98.4%:96.1%,χ~2=0.74,P=0.389).多因素分析显示未放疗(χ~2=14.42,P=0.000)、腋窝淋巴结阳性数≥10个(χ~2=21.60,P=0.000)和T_4期(χ~2=10.79,P=0.001)是总生存率的独立不良预后因素.结论 T_3～T_4期和(或)腋窝淋巴结转移数≥4个乳腺癌患者改良根治术后放疗显著降低局部复发率和提高总生存率,照射部位可选择同侧胸壁和锁骨上淋巴结引流区.     

结外浸润对于淋巴结阳性乳腺癌患者术后放疗获益的影响

  目的   研究结外浸润（extracapsular extension,ECE）对腋窝淋巴结阳性乳腺癌患者术后放疗获益的影响。   方法   按照患者是否接受放疗和结外浸润状态将1 220例淋巴结阳性患者分为“Radio+ECE+”、“Radio-ECE+”、“Radio+ECE-”和“Radio-ECE-”四组,比较四组的局部区域复发率,并通过单因素和多因素分析比较结外浸润对乳腺癌患者无病生存和总生存的影响。   结果   结外浸润对于患者的5年和10年的无局部区域复发生存和总生存的影响具有显著的统计学差异,5year LRFFS（82.69% vs. 91.83%,P < 0.001）,10year LRFFS（75.39% vs. 90.02 %,P < 0.001）;5year OS（52.12% vs. 74.46%,P < 0.001）,10year OS（35.17% vs. 67.63%,P < 0.001）。对于1~3枚或≥10枚阳性淋巴结的患者,结外浸润对于术后放疗获益影响不大,但是对于4~9枚阳性淋巴结的患者,结外浸润对于术后放疗获益差异具有统计学意义。   结论   无论患者的结外浸润情况如何,术后放疗均不会明显提高1~3枚或≥10枚阳性淋巴结患者的无局部区域复发生存,但是对于4~9枚阳性淋巴结的患者,结外浸润是决定是否接受术后放疗的重要指证。      

早期乳腺癌根治术后放疗预后因素分析

目的 探讨早期乳腺癌患者根治术后是否需要接受放疗.方法 回顾性分析本院1998年根治术后经病理证实腋窝淋巴结0～3个阳性的乳腺癌患者270例,其中腋窝淋巴结阴性者156例,腋窝淋巴结转移1、2、3个的分别为60、30、24例(114例).定义预后指数≥4分者为高危患者,<4分者为低危患者.生存率计算采用Kaplan-Meier法并Logrank检验.结果 腋窝淋巴结阴性与1～3阳性者10年生存率、10年无瘤生存率、平均无瘤生存时间、局部复发率、远处转移率分别为75.0%与63.2%(χ~2=4.40,P=0.036),71.2%与59.6%(χ~2=3.90,P=0.048)、(97.03±2.53)个月与(87.01±3.80)个月(t=2.28,P=0.023)、7.7%与16.7%(χ~2=5.22,P=0.022)、12.8%与21.1%(χ~2=3.27,P=0.070).高危组中未放疗者和放疗者的10年生存率分别为56%和72%(χ~2=4.07,P:0.044),局部复发率分别为24%和5%(χ~2=11.16,P=0.001),远处转移率分别为26%和16%(χ~2=2.18,P=0.140).低危组未放疗和放疗者10年生存率分别为71%和81%(χ~2=1.57,P=0.210),局部复发率分别为11%和11%(χ~2=0.01,P=0.975),远处转移率分别为13%和13%(χ~2=0.00,P=1.000).结论 T_1～T_2期腋窝淋巴结1～3个阳性乳腺癌患者根治术后可考虑放疗,预后指数的应用似乎可选择那些复发概率较大患者,从而尽量减少一部分患者接受不必要放疗.     

腋窝淋巴结1～3个转移的早期乳腺癌根治术后局部复发和生存预后因素的研究

背景与目的：腋窝淋巴结1—3个阳性的早期乳腺癌进行辅助放射治疗的指征尚未明确,本研究探讨这部分患者根治术后的局部／区域复发以及生存的危险预后因素。方法：回顾性分析1998年3月至2002年3月在中山大学肿瘤防治中心接受标准或改良根治手术的217例乳腺癌病例的资料,原发肿瘤病理分期pT1期71例,pT2期146例,其中202例接受辅助化疗,51例接受辅助放疗,116例接受术后内分泌治疗。结果：中位随访时间69个月,全组的5年无局部复发生存率、无瘤生存率和总生存率分别为85．2％、81．8％和90．2％。44例出现肿瘤复发,其中21例局部／区域复发。生存分析表明,局部／区域复发患者的5年总生存率明显低于局部／区域控制的患者（61．9％vs93．6％,P〈0．0001）,患者年龄≤35岁、原发肿瘤pT2期和腋窝淋巴结转移比例≥30％是影响无局部复发生存率、无病生存率和总生存率的不良预后因素。根据这3项预后影响因素设立评分系统,发现不同分值病例的5年无局部／区域复发生存率差异具有统计学意义（P=0．0072）。在辅助化疗≥5疗程的159例患者中,接受辅助放疗的35例患者的各项生存率指标均优于未作放射治疗的患者。结论：对于腋窝淋巴结1～3个阳性的早期乳腺癌患者,年龄≤35岁、pT2期原发肿瘤和腋窝淋巴结转移比例≥30％提示术后局部／区域复发危险较高．应考虑辅助放疗。     

763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析

目的 通过对三阴性乳腺癌(Triple-negative breast cancer,TNBC)临床病理特征的分析,探讨影响三阴性乳腺癌患者的复发、转移因素和转移淋巴结与原发灶位置之间关系。方法 收集哈医大附属肿瘤医院2008年12月—2012年12月资料完整的763例三阴性乳腺癌患者的临床资料进行回顾性分析。结果 三阴性乳腺癌平均发病年龄49岁,早期患者占84.7%,淋巴结阳性患者复发、转移率均明显高于淋巴结阴性患者,并随淋巴结数目的增多而增加(P＜0.001),对于淋巴结阴性患者,原发灶位于内象限时复发、转移率最高(9.8%和13.7%)(P＜0.05)。单因素分析显示淋巴结状态、手术方式、放疗剂量是影响三阴性乳腺癌患者复发、转移的因素(P＜0.05)。多因素分析显示临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素(P＜0.05)。结论 (1)三阴性乳腺癌患者早期病例所占比例高,主要病理类型为浸润性导管癌,ki67阳性表达率高;(2)淋巴结阳性患者预后与转移淋巴结数目相关,和原发灶位置无关,对于淋巴结阴性患者,原发灶位于内象限复发、转移率最高;(3)TNBC患者复发率随BMI值的增加而增加,但对于肥胖患者,复发率反而下降;(4)淋巴结状态、临床分期、手术方式、放疗剂量均影响三阴性乳腺癌患者的复发、转移;(5)临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素。     

乳腺癌结外浸润对不同水平腋窝淋巴结受累患者预后的影响

目的:研究淋巴结阳性浸润性乳腺癌患者,不同腋窝淋巴结受累水平下,淋巴结外浸润（Extracapsular extension,ECE ）对患者预后的影响。方法:回顾性分析术后病理证实腋窝淋巴结阳性的原发乳腺癌患者1 230 例,分层研究ECE 在不同腋窝淋巴结受累水平（LN1～3、LN4～9、LN≥10）对总生存率（Overall survival,OS）和无局部/区域复发率（Local-Regional failure free survial ,LRFFS ）的影响,并通过Cox 回归分析肿瘤大小、PER 及ECE 等对不同水平腋窝淋巴结受累患者预后的影响。结果:LN1～3 时,ECE 对OS及LRFFS 的影响均无统计学差异（P=0.931;P=0.591）。 LN4～9 时,ECE 对OS及LRFFS 的影响均有统计学差异（P=0.004;P=0.018）。 LN≥10时,ECE 对OS的影响有统计学意义（P=0.019）,对LRFFS 的影响无显著性差异（P=0.094）。 Cox 回归分析对总体病例进行分析得出,肿瘤大小、PER 及ECE 均为有统计学意义的独立危险因素（P 均<0.05）。 分层分析得出,LN1～3 时,仅肿瘤大小有统计学意义（P=0.006）;LN4～9 时,仅ECE 有统计学意义（P=0.001）;LN≥10时,仅肿瘤大小、PER 有统计学意义（P 均<0.05）。 结论:ECE 是腋窝淋巴结阳性乳腺癌独立预后因素,其对不同水平淋巴结受累患者预后影响不同。对LN≥4 的患者,ECE 可作为判断预后的重要因素,尤其对LN4～9 患者,ECE 为预后不良的独立危险因素。ECE 对不同淋巴结受累水平患者的预后影响不同,可作为临床选择不同治疗方案的依据之一。      

Extracapsular spread of nodal metastasis as a prognostic factor in rectal cancer

PURPOSE: To evaluate the prognostic value of lymph node metastasis with extracapsular extension (ECE) for local control and metastasis-free survival in rectal cancer. METHODS AND MATERIALS: A total of 145 rectal cancer patients were treated with surgery and postoperative radiochemotherapy. Patients were grouped according to nodal status (node negative, n = 49; node positive without ECE, n = 64; node positive with ECE, n = 32). In addition, well-known prognostic factors such as International Union Against Cancer (UICC) stage, T and N stage, presence of lymphangiosis, and grade were assessed. The end points were analyzed by the Kaplan-Meier method, and prognostic factors were compared in a Cox regression model. RESULTS: Of the entire group, the actuarial 5-year local control and distant metastasis-free survival rate was 85% and 66%, respectively, after a median follow-up of 47 months (range, 14-104). Patients with ECE of lymph node metastasis had an impaired 5-year local control rate (58%) compared with node-negative (83%) and node-positive without extracapsular involvement patients (87%, p = 0.041). Metastasis-free survival also differed for the three groups, with a rate of 40% for those with extracapsular involvement, 54% for those without ECE, and 78% for node-negative patients (p <0.0001). The impact of ECE on local control was confirmed in the regression model (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.01-2.7, p = 0.044). T stage was only of borderline significance (RR 2.4, 95% CI 1.0-5.7, p = 0.052). However, only UICC stage (RR 5.1, 95% CI 2.0-13.1, p <0.001) and the presence of lymphangiosis (RR 2.8, 95% CI 1.4-5.3, p = 0.002) were of independent prognostic value for distant metastasis. CONCLUSION: ECE of node metastasis is connected with a substantial decline in local control. The frequency of distant metastasis is increased in this patient group as well, but stage and lymphangiosis are the independent factors for assessment of a patient's risk of systemic spread.     

Prognostic and Predictive Factors of Early Breast Cancer

OBJECTIVE To identify risk factors for relapse and death in patients with T1 to T2 breast cancer with 0-3 positive axillary lymph nodes.METHODS The case files of 540 breast cancer patients with T1-T2 tumors with 0-3 positive nodes were reviewed retrospectively. Ten-year locoregional recurrence (LRR), distant recurrence (DR), disease-free survival (DFS) and overall survival (OS) of the patients were analyzed. Univariate statistical analysis and Cox proportional hazards models were carried out with SPSS so ware v.16.0.RESULTS The median follow-up of all the patients was 7.2 years. On multivariate analysis, > 20% positive axillary nodes was the only variable that influenced LRR adversely (hazard ratio[HR], 12.816; 95% confidence interval, 4.657-35.266, P < 0.001); > 20% positive axillary nodes and ductal carcinoma were variables that influenced DR adversely (HR, 11.088, 95% confidence interval, 3.807-32.297, P < 0.001; HR, 0.390, 95% confidence interval, 0.179-0.851, P = 0.018); 1-3 positive axillary nodes and > 20% positive axillary nodes were the only variables that had negative e. ect on 10-year OS (HR, 2.110, 95% confi dence interval, 1.364-3.264, P = 0.001; HR, 10.244, 95% confidence interval, 3.497-30.011, P < 0.001) and they were also adverse prognostic variables on 10-year DFS (HR, 1.634, 95% confidence interval, 1.171-2.279, P = 0.004; HR, 7.339, 95% confi dence interval,2.906-18.530, P < 0.001).CONCLUSION Axillary lymph nodal status is the only risk factor with a signifi cant impact on 10-year LRR, DR, OS and DFS.Patients with T1-T2 breast cancer with 0-3 positive lymph nodes have the LRR and DR of over 10 years, and the OS and DFS of less than 10 years, compared to patients with negative lymph nodes.Histology in primary tumors is a signifi cant prognostic factor for the 10-year DR.     

The importance of extracapsular extension of axillary lymph node metastases in breast cancer

PURPOSE: To evaluate the prognostic value of extracapsular extension (ECE) of axillary lymph node metastases in 221 patients with axillary lymph node-positive, T1-T2 breast cancer treated at Dokuz Eylul University Hospital, Department of Radiation Oncology. PATIENTS AND METHODS: The clinical records of patients with axillary node-positive, pathological stage II-III breast cancer examined at Dokuz Eylul University Hospital, Department of Radiation Oncology, between 1991-1999 were reviewed. All patients underwent modified radical mastectomy (MRM) or wide excision with axillary node dissection. Axillary surgery consisted of level I-II dissection. The number of lymph nodes dissected from the axilla was equal to or more than 10 in 92% of the patients. All 221 patients had pathological T1-T2 tumors. The number of involved lymph nodes was four or more in 112 51% patients and less than four in the remaining 109 (49%). In 127 (57.5%) patients, extracapsular extension was detected in axillary lymph nodes. Tangential radiotherapy fields were used to treat the breast or chest wall. Lymphatic irradiation was performed in 215 (97%) patients with fields covering both the supraclavicular and axillary regions. Median radiotherapy dose for lymph nodes was 5000 cGy in 25 fractions. The following factors were evaluated: age, menopausal status, histological tumor type, pathological stage, number of involved axillary lymph nodes, and extracapsular extension. The chi-square test was used to compare proportions of categorical covariates between groups of patients with and without ECE. Survival analyses were estimated with the Kaplan-Meier method. The Cox regression model was used for the analysis of prognostic factors. RESULTS: The median follow-up for the survivors was 55 months (range, 19-23). The median age was 52 years (range, 28-75). In patients with extracapsular extension the percentages of pathological stage III (22% vs 4.3%, P < 0.0001 and involvement of four or more axillary nodes (25.5% vs 69.3%, p < 0.0000) were higher. Multivariate analysis revealed a significant correlation between the presence of ECE and disease-free survival (DFS) (P = 0.04) as well as distant metastases-free survival (DMFS) (P = 0.002), but there was no significant correlation between ECE and overall survival (OS). Only an elevated number of involved axillary lymph nodes significantly reduced the overall survival (P = 0.001). CONCLUSION: The rate of extracapsular extension was found to be directly proportional to the number of axillary lymph nodes involved and the stage of disease. Extracapsular extension had significant prognostic value in both univariate and multivariate analysis for DFS and DMFS but not OS. The reason for ECE not affecting OS might be related to the much more dominant prognostic effect of the involvement of four or more axillary nodes on OS. Studies with more patients are needed to demonstrate that ECE is a likely independent prognostic factor for OS.     

Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy

BACKGROUND: The purpose of this study was to analyze the prognostic factors affecting local control and survival rates for patients with early breast cancer who received breast conserving treatment (BCT) and to find out the optimal treatment according to their risk factors. METHODS: From October 1994 to December 2001, 605 patients with 611 stage I and II breast cancers received BCT, and the results were analyzed retrospectively. BCT consists of breast conserving surgery and whole breast irradiation. All the patients underwent lumpectomy or quadrantectomy. Axillary lymph node dissection or sentinel lymph node biopsy was performed in 608 cases (99.5%). The radiation dose to the whole breast was 50.4 Gy over 5 weeks with a 1.8 Gy daily fraction and with boost doses of 9-14.4 Gy administered to the tumor bed. Adjuvant chemotherapy was performed in most of the patients with axillary lymph node metastasis or tumors larger than 1 cm. The median follow-up period was 47 months. RESULTS: Local relapse, regional relapse and distant metastasis occurred in 15 (2.5%), 16 (2.6%) and 43 patients (7.1%), respectively. The 5-year overall survival, local-relapse-free survival, distant-metastasis-free survival and disease-free survival rates were 95.3%, 97.2%, 91.3% and 88.5%, respectively. On multivariate analysis, age (P = 0.02), number of involved axillary lymph nodes (P = 0.01) and nuclear grade (P = 0.01) affected the local-relapse-free survival. The factors associated with disease-free survival were the T stage (P = 0.05), number of involved axillary lymph nodes (P = 0.01) and nuclear grade (P = 0.001). Overall survival was associated with the T stage (P = 0.02), number of involved axillary lymph nodes (P = 0.01) and c-erb B2 overexpression (P = 0.05). Patients with more than two factors among (i) age 1 cm, (ii) positive lymph node metastasis and (iii) high nuclear grade showed an inferior 5-year disease-free survival rate compared with others (P = 0.0005). CONCLUSIONS: The most important prognostic factor affecting local control, disease-free survival and overall survival was axillary lymph node metastasis. The nuclear grade influenced local control and disease relapse. Patients with multiple unfavorable risk factors such as positive axillary lymph nodes, high nuclear grade, young age and large tumor showed poorer local control and disease-free survival than patients without any risk factors, and so more aggressive treatment is required for these patients.     

术后放疗在T1～T2期腋窝淋巴结1～3个转移乳腺癌中的临床应用

目的探讨T1～T2期腋窝淋巴结1～3个转移乳腺癌改良根治术后放疗的疗效及影响术后复发的相关因素。方法回顾分析496例腋窝淋巴结1～3个转移的早期患者,所有患者均行乳腺癌改良根治术,术后行放射治疗者210例,未行放疗者286例。术后随访满5年,组间差异采用χ2检验,影响复发率的多因素分析采用Logistic回归分析。结果全组5年生存率：92.3%（458/496）,5年局部复发率7.3%（36/496）,远处转移率12.1%（60/496）。术后放疗组与未放疗组的局部复发率分别为4.3%和9.4%（χ2=4.780,P=0.029）。Logistic回归分析提示,术后复发与是否行肿瘤局切术[Exp（B）=3.420,P=0.004]、月经状况[Exp（B）=0.336,P=0.032]、肿块位置[Exp（B）=4.744,P=0.000]、淋巴结清扫个数[Exp（B）=5.507,P=0.000]相关。结论术后放疗可降低T1～T2期腋窝淋巴结1～3个转移乳腺癌患者的局部复发率;肿瘤局切术后、绝经前、肿块位于中央区或内象限、淋巴结清扫数〈10个等为影响肿瘤复发的独立高危因素,对这部分患者应积极考虑行术后放疗。     

Extent of extracapsular spread: a critical prognosticator in oral tongue cancer

BACKGROUND: Extracapsular spread (ECS) of metastatic squamous cell carcinoma of the head and neck to regional lymph nodes is the most reliable predictor of poor treatment outcomes. Recently, the authors have shown that ECS is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival in patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this review was to determine if the degree of ECS impacts distant metastasis rates and survival. METHODS: Two hundred sixty-six patients treated for SCCOT with surgery +/- adjuvant radiotherapy from 1980-1995 were reviewed. The setting was a tertiary referral center. The extent of ECS on histopathologic review of involved lymph nodes was measured from the capsular margin to the farthest perinodal extension in mm. Extent of ECS and the number of pathologic lymph nodes with or without ECS were analyzed for disease-free interval, survival rates, and distant metastases. RESULTS: No differences in the survival of patients with ECS of 2 mm was found (P = 0.92). Patients with both ECS and multiple positive lymph nodes had decreased overall survival (P = 0.0003), disease-specific survival (P = 0.0005), and a shorter disease-free interval (P = 0.019) when compared with those with a single positive lymph node with ECS. Those with multiple ECS+ lymph nodes had the worst prognosis (P = 0.001). CONCLUSIONS: Based on these findings, the authors recommended that all patients with SCCOT with ECS or multiple positive lymph nodes with or without ECS on pathologic review be considered for clinical trials that intensify regional and systemic adjuvant therapy.     

The correlation of extranodal invasion with other prognostic parameters in lymph node positive breast cancer

BACKGROUND: The presence of extranodal invasion (ENI) in the metastatic lymph nodes is reported to increase the risk of locoregional recurrence while shortening disease-free and overall survival in patients with breast cancer. In this study the relationship between ENI and other prognostic parameters and survival is investigated. METHODS: Of 650 patients with breast cancer who were treated in Ankara Oncology Teaching and Research Hospital from 1996 to 2003, 368 (56.6%) had lymph node metastasis. The patients with axillary metastasis were separated into two groups as with and without invasion to lymph node capsule and the surrounding adipose tissue. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. RESULTS: Of 368 patients with axillary metastasis, 135 (36.7%) had ENI. Based on multivariate analysis; the number of metastatic lymph nodes, lymphatic invasion, and tumor necrosis were found to be related with ENI. In the group with ENI, 5-year overall survival rate was 74.8%, compared to 82.3% for patients without ENI which was significantly lower (P = 0.04). CONCLUSIONS: In lymph node positive breast cancer with presence of ENI, adverse prognostic parameters are more frequently encountered and has a worse overall survival compared to group without ENI.