乳腺癌腋窝淋巴结外软组织转移对患者生存期的影响

Axillary lymph node extranodal soft tissue extension: a significant prognostic factor in breast carcinoma patients

目的：通过对乳腺癌不同水平的淋巴结转移及结外软组织转移（ETE）者的预后分析，研究ETE对乳腺癌患者生存期的影响。方法：选取1990～1993年乳腺癌病例620例，随访率99．7％（618／620）。复习全部病例，确定相关变量，并对变量进行定义和编辑，建立数据库，使用SPSS10．0统计学软件进行分析。结果：620例中49．8％（309／620）伴有腋窝淋巴结转移，其中29．8％（92／309）出现ETE。单纯淋巴结转移的患者5年总生存率（OS）及无瘤生存率（DFR）均为72．8％（158／217）；10年OS 65．0％（141／217），DFR 62．2％。淋巴结转移伴ETE者5年OS 40．2％（37／92），10年OS 27．1％（25／92），X^2分别为29．5和37．1，P=0．000。相关性分析显示，ETE与生存期呈负相关，r=-0．404，P=0．000，有高度相关性。COX回归分析显示，X^2=103．726，P=0．000，RR=5．066（95％CI为3．721～6．898），说明伴有ETE的患者，其血行转移和死亡的可能性是无ETE者的5倍。判别分析显示，与淋巴结转移数目和淋巴结转移水平相比，ETE对生存期的影响最小。结论：乳腺癌腋窝ETE与生存密切相关，虽然与淋巴结转移数目和淋巴结转移水平相比，ETE对生存期的影响最小，但用于判定乳腺癌预后,指导临床治疗仍是一个非常有意义的指标。

OBJECTIVE： To clarify the prognostic factors in breast cancer patients with extranodal soft tissue extension（ETE）. METHODS： A total of 620 connective breast carcinoma patients with modified redical mastectomy were involved in this study, and axillary lymph nodes dissection included level Ⅰ , level Ⅱ and level Ⅲ. At least 20 lymph nodes were found for pathology diagnosis in each case. The follow up rate was 99.7% （618/620）. RESULTS： 49.8% （309/620） of all the patients were local regional lymph nodes metastases, and 29.8% （92/309） of them were extranodal soft tissue extension （ETE）. The five years overall survival （OS） and disease free survival （DFS） of those with lymph nodes metastases were both 72.8% （158/217）, respectively. OS and DFS of 10 years were 65.0% （141/217） and 62.2%, respectively. Five and 10 years OSs of the patients with both axillary lymph nodes and ETE were 40.2% （37/92） and 27. 1% （25/92） respectively X^2 being 29.5 and 37. 1, P = 0. 000. Statistical analysis showed that ETE correlated with survival negatively, r=- 0. 404, P= 0. 000. COX regression analysis showed that X^2 = 103. 726, P= 0. 000, RR=5. 066 （95%CI, 3. 721-6. 898）, demonstrating that cases with ETE had five times of possibility of distant metastases and mortality compared with the cases without ETE. The discriminated showed that the effect of tumor was microvessels count on survival time was more significant than lymph nodes micrometastasis. CONCLUSlONS： Although the influence of ETE to the survival is weaker than that of level and number of local regional lymph nodes metastases, it still correlats with the survival period of breast carcinoma patients and is a significant prognostic and therapeutic index in breast cancer patients.