腋窝淋巴结转移对浸润性乳腺癌预后的影响

Influence of Axilla Lymphatic Metastasis to Prognosis of Infiltrating Breast Cancer

目的:腋窝淋巴结(ALN)转移数目是影响浸润性乳腺癌预后最重要的因素,本研究明确淋巴结转移(LNM)数目与无瘤生存期的关系,并将其作为判断乳腺癌预后的标志。方法:180例行全乳+ALN I、II平面解剖术病例,摘取全数LN作连续6张切片,由病理切片报告浸润癌最大径。并根据PN和PT结果,选择化疗和(或)内分泌治疗方案。记录乳腺癌患者的年龄、肿瘤大小、ALN检查数、转移数。分别用t检验、χ2检验进行统计学分析。按Kaplan-Meier方法计算生存率,并对其进行Log-rank检验。结果:180例中,95例有ALNM,ALNM发生率为53%。其中N085例;N152例;N220例;N323例。ALNM数随肿瘤大小增加而升高。总的5年无瘤生存率88%,无ALNM者,5年无瘤生存率为99%;一旦出现ALNM,5年无瘤生存率则降至79%(P<0.01)。结论:腋窝淋巴结状况是乳腺癌重要的预后因素。淋巴结转移数目、孕激素受体是判断预后的指标。切除淋巴结数应超过10枚,以便准确N分期。

Objective ： The number of axillary lymph node （ALN） metastasis is the most impor- tant prognostic factor in the patients with infiltrating breast cancer. The purpose of this study is to de- termine the relationship between the number of nodal metastasis and the survival time without tu- mor, and make it to be a sign of the breast cancer prognosis. Methods： 180 cases with full breast＋ ALN Ⅰ, Ⅱ plane dissection, picked up all the LN, consecutively made 6 slices, reported the maxi- mum gauge with pathological slice. In accordance with pN and pT results, chose the chemo-treat- ment and or or incretion treatment. Recorded the breast cancer patients＇ age, tumor size, ALN checked number, metastasis number. Carried out stastieal analysis with t test and Z2 test. Calculat- ed the survival rate with Kaplan-Meier method, and carried out log-rank test. Results： In 180 cas- es, 95 cases had ALNM, the occuring rate of ALNM was 53%. Among it, No 85 cases, Nt 52 cases, N2 20 cases, N3 23 cases. The number of ALNM increased as the tumor size going up. The general survival rate in 5 years without tumor was 88%, the patients without ALNM, 5 years survival rate without tumor was 99% ; once appeared ALNM, 5 years survival rate without tumor decreased to 79% （P 〈 0.01 ）. Conclusion ： The condition of axilla lymph node is an important factor to prognosis of breast cancer. The number of lymphatic metastasis and the progesterone receptor are the index for prognosis. The cutted number of lymphnode should be more than 10, for accurately judging the N level.