腋窝淋巴结切检数目对腋窝淋巴结阳性乳腺癌预后的影响

目的腋窝淋巴结阳性数目是影响乳腺癌预后最重要的因子之一，而切除的淋巴结数目（1ymph nodes number，LNN）可能影响淋巴结阳性数目。故探讨评价LNN对淋巴结阳性乳腺癌预后的影响。方法根据LNN不同，将行全乳切除和腋窝淋巴结清扫手术的腋窝淋巴结阳性乳腺癌449例分为：A组（LNN〈10）123例，B组（LNN≥10）326例。比较2组临床病理特征，分别使用Kaplan-Meier法和Cox风险模型对患者的无病生存（disease-freesurvival，DFS）进行单因素和多因素生存分析。结果A组的pNl、高淋巴结阳性比例和辅助放疗的比例明显高于B组。平均随访：A组43．59个月，B组41．34个月，有可比性。单因素分析显示：pN分期、LNN、淋巴结阳性比例、HER-2、辅助化疗方案和辅助放疗是影响DFS的因素。多因素分析显示：pN分期、LNN、淋巴结阳性比例、辅助化疗方案和辅助放疗是影响DFS的因素。分层分析显示：在A组中，使用含紫杉类化疗方案和进行辅助放疗的DFS明显优于不使用含紫杉类化疗方案和不进行辅助放疗的DFS，而2种辅助治疗方案对B组的DFS无明显影响。结论LNN的减少可能影响淋巴结阳性患者的病情判断和治疗选择。LNN是预测腋窝淋巴结阳性乳腺癌患者DFS的一个经济、有效因子。使用含紫杉类化疗方案和进行辅助放疗可弥补LNN不足对DFS的不良影响。

The prognostic value of the resected lymph nodes number in breast cancer with positive axillary lymph nodes

Objective The number of positve axillary lymph nodes （ALNs） is one of the most important factors affecting prognosis of patients with breast cancer. The resected lymph nodes number（LNN） can affect the number of positive ALNs. In this study, we aim to evaluate the influence of LNN on the progonosis of breast cancer patients with positive ALNs. Methods 449 breast cancer patients with positive ALNs who underwent total mastectomy and axillary dissection were divided into 2 groups：group A （LNN 〈 10）and group B （LNN /〉 10）. The clinicopathological features of the 2 groups were compared. Kaplan-Meier method and Cox proportional hazard method were respectively used to make univariate and multivariate survival analysis for disease-free survival （DFS）. Results The median follow-up was 43.59 months for group A and 41.34 months for group B. Group A had a significantly higher proportion of patients in pN1, with lymph node metastasis and adjuvant radiotherapy than group B. Univariate analysis showed pN stage, LNN, lymph nodes metastasis rate, HER-2, adjuvant chem- otherapy regime and adjuvant radiotherapy were factors influencing DFS. Multivariate analysis showed that pN stage, LNN, lymph nodes metastasis rate, adjuvant chemotherapy regime and adjuvant radiotherapy were factors influencing DFS. We performed analysis stratified by adjuvant chemotherapy regime containing taxan and adjuvant radiotherapy. Stratified analysis showed patients with adjuvant chemotherapy regime containing taxus and adjuvant radiotherapy showed significantly higher DFS rate than those without taxus in adjuvant chemotherapy regime or without adjuvant radiotherapy in group A. However, the 2 different treatment regime had no difference in DFS rate for patients in group B. Conclusions The decrease of LNN may affect the diagnosis and therapeutic selection of breast cancer patients with positive ALNs. LNN is an inexpensive and easily available factor for predictin~ DFS ofbreast cancer patients with positive ALNs. Adjuvant chemotherapy regime containing taxus and adjuvant radiotherapy can improve DFS rateof patients with LNN 〈 10.