354例T1期乳腺癌患者的淋巴结转移和预后分析

Lymph node metastasis and prognostic analysis of 354 cases of T1 breast cancer

目的分析T1期乳腺癌患者的淋巴结转移和预后的特点。方法收集2007年3月至2011年9月间354例T1期乳腺癌患者的临床资料，分析T1期乳腺癌患者的临床病理特征与淋巴结转移的关系和预后特点。结果354例T1期乳腺癌患者中，淋巴结转移105例，淋巴结转移率为29．7％。其中淋巴结转移1～3枚者73例（69．5％），≥4枚者32例（30．5％）。T1a期患者的淋巴结转移率为8．3％，T1b期患者的淋巴结转移率为39．7％，T1C期患者的淋巴结转移率为30．4％（P=0．005）。两两比较显示，T1a期与T1b期和T1c期乳腺癌患者的淋巴结转移率差异有统计学意义（P=0．001，P=0．006），T1b期和T1C期乳腺癌患者的淋巴结转移率差异无统计学意义（P=0．171）。354例T1期乳腺癌患者中，92例患者有脉管瘤栓，其淋巴结转移率为71．7％；262例患者无脉管瘤栓，其淋巴结转移率为14．9％（P〈0．001）。中位随访时间49个月，12例患者复发，3例死亡，其中1例死于脑血管意外。全组患者的4年无病生存率为96．6％，4年生存率为99．2％。结论T1期乳腺癌患者脉管瘤栓和肿瘤大小与淋巴结转移率有关，T1a期乳腺癌患者的淋巴结转移率较低，T1b期和T1c期乳腺癌患者的淋巴结转移率相对较高。与无脉管瘤栓患者比较，有脉管瘤栓的T1期乳腺癌患者淋巴结转移率更高。T1期乳腺癌患者的预后较好。

Objective To analyze the characteristics of lymph node metastasis and prognosis in patients with T1 breast cancer. Methods The clinicopathologieal data of 354 patients with T1 breast cancer after standard treatment from March 2007 to September 2011 were collected to analyze the relationship between the clinical characteristics of T1 breast cancer, lymph node metastasis and prognostic features. Results In the 354 patients with T1 breast cancer, 105 patients （29.7%） had lymph node metastasis, among them 73 cases （69.5%） had 1-3 lymph node metastasis, and 32 cases （30.5%） had more than 4 lymph node metastasis. The lymph node metastasis rate was 8.3% in Tla patients, 39.7% in Tlb patients, and 30.4% in Tlc cases （ P = 0. 005 ）. Pairwise comparison showed that the difference of lymph node metastasis rate between Tla,Tlb and Tlc patients was statistically significant （ P = 0. 001 and P = 0. 006, respectively）. The difference of lymph node metastasis rates in Tlb and Tlc patients was statistically insignificant （P = 0.171 ）. In the 354 patients of T1 breast cancer, 92 patients had vascular tumor thrombi and their lymph node metastasis rate was 71.7% , while the lymph node metastasis rate in 262 patients without vascular tumor thrombus was 14.9% （ P 〈 0. 001 ）. The median follow-up was 49 months （ range 27- 81 months）. 12 patients developed recurrence, and 3 patients died, one of them died of cerebrovaseular accident. The 4-year disease-free survival for all patients was 96.6% , and the 4-year overall survival rate was 99.2%. Conclusions There is a correlation between vascular tumor thrombus, tumor size and lymph node metastasis rate. The lymph node metastasis rate is lower in Tla patients and relatively higher in T1b/c patients. Compared with patients without vascular tumor thrombus, the T1 breast cancer patients with vascular tumor thrombi have a higher lymph node metastasis rate. Generally speaking, there is a still good prognosis in patients with T1 breast cancer.