淋巴结转移数和淋巴结转移率与乳腺癌预后关系的分析比较

  目的  探讨淋巴结转移率(lymph node ratio, LNR)是否能更优于淋巴结转移数(positive lymph nodes, PLN), 用于评价乳腺癌术后患者的复发风险和总生存时间。  方法  回顾性分析1089例淋巴结清扫数目为10枚或以上、术后经病理证实淋巴结转移阳性的原发性浸润性乳腺癌患者临床病理资料。  结果  单因素生存分析, 肿瘤大小分期, 组织学分级、ER/PR/HER-2状态、PLN、LNR、切检淋巴结总数、结外软组织侵犯、辅助治疗与患者RFS(relapse free survival, RFS)、OS(overall survival, OS)均具有明显的相关性(P < 0.05);多因素生存分析, 当PLN和LNR作为协变量分别进入Cox比例风险模型时, PLN和LNR均为患者RFS和OS的独立预测指标(P < 0.001);当PLN和LNR作为协变量同时进入Cox比例风险模型时, LNR依然是患者RFS和OS的独立预测指标(RFS: P < 0.001.OS: P=0.001), 而PLN不再是其独立预测指标(RFS: P=0.944, 0S: P=0.315)。  结论  相对于PLN而言, LNR能更好的评价乳腺癌术后患者的复发风险和总生存时间, 为乳腺癌危险度分级和临床医生制定辅助治疗方案提供更有力的参考依据。 

Comparison of the Prognostic Significance between Positive Lymph Nodes and Lymph Node Ratio of Breast Carcinoma

  Objectives  To investigate if lymph node ratio(LNR) is better than positive lymph nodes(PLN) in evaluating recurrence hazard and overall survival time of breast carcinoma patients.  Methods  The medical records of 1, 089 primary invasive breast cancer patients were retrospectively analyzed.All the patients have 10 or more lymph nodes identified in axillary dissection and presented with one or more PLN.which were confirmed by postoperative pathological examination.  Results  In univariate analyses, pT-stage, grade, ER / PR /HER-2 status.PLN, LNR.total lymph nodes dissected, extranodal soft tissue invasion, and adjuvant treatment(chemotherapy, radiotherapy, and endocrine therapy) were associated significantly with relapse-free survival(RFS) and overall survival(OS)(P < 0.0?).In multivariate analyses, when PLN or LNR were entered into the Cox hazard ratio model as covariate, both PLN and LNR were the dependent prognostic factors of RFS(P < 0.001) and OS(P < 0.001).When PLN and LNR were entered into the Cox hazard ratio model as covariates at the same time.LNR remained as the dependent prognostic factor of RFS(P < 0.001) and OS(P = 0.001), but PLN lost significance(RFS: P = 0.944, OS: P=0.315).  Conclusion  Compared with the number of involved lymph nodes.LNR can predict recurrence hazard and OS more efficiently.It provides a more powerful reference for breast cancer risk classification, allowing clinicians to make decisions on adjuvant therapy.