新辅助化疗后锁骨上淋巴结病理完全缓解和乳腺癌患者预后的关系

Relationship between pathologically complete response of metastatic supraclavicular lymph nodes and the prognosis of breast cancer patients after neoadjuvant chemotherapy and surgery

目的探讨乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解的相关因素及其与预后的关系.方法回顾性分析连续收集的初诊伴同侧锁骨上淋巴结转移且接受新辅助化疗及锁骨上淋巴结清扫术的234例乳腺癌患者的临床资料.结果入组患者均为女性,中位年龄52岁.锁骨上淋巴结病理完全缓解率(spCR)为52.6%,多因素分析显示,Ki67表达水平、乳腺及腋窝淋巴结病理完全缓解状态、锁骨上淋巴结清扫数目是spCR的独立相关因素(均P<0.05).中位随访时间16.6个月,获得spCR患者的复发转移风险较病理未完全缓解者降低了51%(HR=0.49,95%CI0.27~0.89,P=0.020),且主要在激素受体阴性患者中.spCR是患者无复发生存(DFS)的独立预后因素.结论Ki67表达水平、乳腺及腋窝淋巴结病理完全缓解状态、锁骨上清扫淋巴结数目是新辅助化疗后spCR的独立相关因素,spCR是患者DFS的独立预测因素.

Objective To investigate the correlation between ipsilateral metastatic supraclavicular lymph nodes(ISLN)pathologically complete response(spCR)and the prognosis in breast cancer after neoadjuvant chemotherapy(NAC)and lymphadenectomy.Methods Clinical data of 234 breast cancer patients with ISLN at the time of diagnosis and receiving supraclavicular lymph node dissection following NAC were retrospectively analyzed.Results All patients were female,with a median age of 52 years.The spCK rate was 52.6%.Multivariate analysis showed that the expression level of Ki67,the pathological status of breast and axillary nodes and the dissection number of supraclavic ular lymph node were independent relate factors for spCR(all P<0.05).After a median follow-up of 16.6 months,the risk of recurrence and metastasis in the spCR group was 51%.It was lower than that in the non-spCR group(HR=0.49,95%CI0.27-0.89,P=0.020).It was mainly manifested in hormone receptor negative patients.Supraclavicular spCR was an independent prognostic factor for DFS.Conclusions The expression level of Ki67,pathological state of breast and axillary node and the dissection number of supraclavicular lymph node were independent related factors of spCR,which was also an independent predictor of DFS.