淋巴结转移率评价腋窝淋巴结转移的保乳治疗乳腺癌患者预后的价值

Prognostic value of metastatic axillary lymph node ratio in node-positive breast cancer treated by breast conserving surgery

目的探讨淋巴结转移率（LNR）评价接受保留乳房治疗（BCT）并发生腋窝淋巴结转移的乳腺癌患者的预后是否优于pN分期。方法回顾性分析1998--2007年问152例接受BCT并发生腋窝淋巴结转移的原发浸润性乳腺癌患者的临床资料，比较LNR和pN分期评价乳腺癌患者无病生存率和总生存率的价值。结果152例患者中，pN1期114例，pN2期23例，pN3期15例。LNR≤0．20者114例，LNR为0．21～0．65者26例，LNR〉0．65者12例。单因素分析显示，淋巴结切检总数、pN分期、LNR、雌激素受体状态、孕激素受体状态、放疗均与患者的无病生存率和总生存率有关（均P〈0．05）；诊断年龄和化疗方案仅与患者的总生存率有关（均P〈0．05）。多因素分析显示，LNR为影响患者无病生存率和总生存率的独立因素（均P〈0．05），而pN分期与患者的无病生存率和总生存率无关（均P〉0．05）。在不同pN分期中，LNR也与患者的预后有关。结论在评价接受BCT、发生淋巴结转移的乳腺癌患者预后时，LNR作为一个独立的预测指标，更优于pN分期。

Objective To evaluate the prognostic value of lymph node ratio （LNR） as compared with the number of pN staging in patients with axillary lymph node-positive breast cancer treated by breast conserving surgery. Methods We performed a retrospective analysis of the clinical data of patients who received breast conserving surgery and with positive lymph nodes （n = 152） between 1998 and 2007. The disease-free survival （DFS） and overall survival （OS） were compared based on the LNR and pN staging. Results A total of 152 patients were classified as pN1 in 114, pN2 in 23, and pN3 in 15 cases. Among the 152 cases, 114 cases had a LNR ≤0.20, 26 cases had 0.21-0.65, and 12 cases had a LNR 〉0.65. Univariate analysis showed that number of dissected lymph nodes, LNR, pN stage, ER/PR status and radiotherapy were significant prognostic factors for DFS and OS （ P 〈 0.05 for all）. Age and chemotherapy were prognostic factors only for OS （P 〈 0. 05 ）. Multivariate analysis indicated that LNR was an independent prognostic factor for DFS and OS （ P 〈 0.05 for both）, pN stage had no significant effect on DFS or OS （ P 〉 0. 05 for both）. In the pN subgroup analysis, LNR was also showed to be significantly correlated with the prognosis of patients. Conclusions LNR is superior to pN staging as a prognostic factor in axillary lymph node-positive breast cancer patients treated by breast conservation surgery, and can be used as one of independent prognostic predictors for the patients.