同侧锁骨上淋巴结转移对N3期乳腺癌预后的影响

Analysis of the effect of ipsilateral supraclavicular lymph node metastasis on the prognosis of N3 breast cancer

目的探讨同侧锁骨上淋巴结转移对N3期乳腺癌预后的影响以及美国癌症联合委员会(AJCC)第6版乳腺癌分期的合理性。方法回顾性分析初诊淋巴结分期为N3期的321例乳腺癌患者的临床病理资料,通过倾向评分匹配(PSM)对不同部位淋巴结转移的N3期患者进行匹配分组,主要研究终点为无病生存时间(DFS),次要研究终点为总生存时间(OS)。生存分析采用Kaplan-Meier法和Log rank检验。结果应用PSM法进行2次匹配,第1次匹配无锁骨上淋巴结转移(腋窝组)和含锁骨上淋巴结转移(锁骨上±腋窝组)的N3期乳腺癌各78例,腋窝组和锁骨上±腋窝组患者的中位DFS分别为58.9和32.1个月(P=0.101),中位OS分别为87.4和140.4个月(P=0.277)。第2次匹配腋窝组和仅锁骨上淋巴结转移锁骨上组的N3期乳腺癌患者各51例,腋窝组和锁骨上组患者的中位DFS分别为59.0和44.0个月(P=0.533),中位OS分别为87.4和137.1个月(P=0.289)。结论乳腺癌同侧锁骨上淋巴结转移与无锁骨上淋巴结转移N3期患者的预后相似,AJCC第6版乳腺癌TNM分期将其划入淋巴结转移N3期具有合理性。

Objective The 6th edition American Joint Committee on Cancer(AJCC)staging system for breast cancer classifies ipsilateral supraclavicular lymph node metastasis(ISLM)downing stage from M1 to N3,suggesting more patients might receive radical treatment.The aim of this study was to analyze the effect of ISLM on the prognosis of N3 breast cancer and verify the rationality of modified staging.Methods A total of 321 breast cancer patients with N3 according to the 6th edition AJCC staging system were retrospectively analyzed.Propensity Score Matching(PSM)was used to pair the different subgroups of N3.The primary end point was disease-free survival(DFS),the secondary end point was overall survival(OS).Kaplan-Meier method was used to calculate the DFS and OS.The differences between two groups were analyzed by the Log-rank test.Results After PSM pairing twice,78 patients with none-ISLM and 78 patients with ISLM were enrolled in the first group;51 patients with none-ISLM was compared patients with isolated ISLM in the second group.The results of the two groups showed that patients with none-ISLM have a prolonged DFS(the first group:58.9 months vs 32.1 months,P=0.101;the second group:59.0 months vs 44.0 months,P=0.533),while the OS was opposite(the first group:87.4 months vs 140.4 months,P=0.289;the second group:87.4 months vs 137.1 months,P=0.289).Conclusions The prognosis of breast cancer patients with ISLM is similar to that of patients with none-ISLM in stage N3.It is reasonable to include ISLM in N3 in the 6th edition AJCC staging system.Yet,prospective studies with larger sample size are needed to further confirmation.