CAJ | 학술논문

目的探讨乳腺癌患者淋巴结外侵犯(ECE)的临床意义.方法回顾性分析1230例腋窝淋巴结阳性乳腺癌,观察ECE与临床病理指标之间关系及对患者预后的影响.结果腋窝淋巴结阳性乳腺癌患者中,ECE阳性率为39.5%.绝经前和绝经后患者ECE的发生率分别为35.5%和47.5%(P＜0.001).ECE阳性组和阴性组的肿瘤直径分别为5.11±2.53 cm和3.90±1.80 cm(P＜0.001),肿瘤直径越大,ECE阳性比例越高(P＜0.001).ECE阳性患者和ECE阴性患者的阳性淋巴结数目分别为16.96±12.16和5.24±6.60(P＜0.001),随腋窝阳性淋巴结数目增多,ECE阳性率明显增加(P＜0.001).ECE的发生与ER、PR状态无显著相关(P=0.706).ECE足乳腺癌患者局部或区域复发的危险因素(P＜0.001),复发时间差异无统计学意义(P=0.559).ECE阳性组和ECE阴性组的远处转移时问分别为30.0个月和37.5个月(P=0.006).首发骨、皮肤和远隔淋巴结组及内脏转移组的ECE阳性率分别为60.4%和42.0%(P=0.001).ECE阳性患者的无转移生存时间、无局部或区域复发生存时间及总生存时间均小于ECE阴性患者.预后单因素和多因素分析显示,ECE是影响乳腺癌患者无转移生存时间、无局部或区域复发生存时间及总生存时间的独立危险因素.结论乳腺癌患者ECE的发生与肿瘤直径和受累淋巴结数日呈正相关;ECE是乳腺癌局部或区域复发和远处转移的危险因素;ECE是影响乳腺癌患者无转移生存时间、无局部或区域复发生存时间及总生存时间的危险因素.
목적 탐토유선암환자림파결외침범(ECE)적림상의의.방법 회고성분석1230례액와림파결양성유선암,관찰ECE여림상병리지표지간관계급대환자예후적영향.결과 액와림파결양성유선암환자중,ECE양성솔위39.5%.절경전화절경후환자ECE적발생솔분별위35.5%화47.5%(P＜0.001).ECE양성조화음성조적종류직경분별위5.11±2.53 cm화3.90±1.80 cm(P＜0.001),종류직경월대,ECE양성비례월고(P＜0.001).ECE양성환자화ECE음성환자적양성림파결수목분별위16.96±12.16화5.24±6.60(P＜0.001),수액와양성림파결수목증다,ECE양성솔명현증가(P＜0.001).ECE적발생여ER、PR상태무현저상관(P=0.706).ECE족유선암환자국부혹구역복발적위험인소(P＜0.001),복발시간차이무통계학의의(P=0.559).ECE양성조화ECE음성조적원처전이시문분별위30.0개월화37.5개월(P=0.006).수발골、피부화원격림파결조급내장전이조적ECE양성솔분별위60.4%화42.0%(P=0.001).ECE양성환자적무전이생존시간、무국부혹구역복발생존시간급총생존시간균소우ECE음성환자.예후단인소화다인소분석현시,ECE시영향유선암환자무전이생존시간、무국부혹구역복발생존시간급총생존시간적독립위험인소.결론 유선암환자ECE적발생여종류직경화수루림파결수일정정상관;ECE시유선암국부혹구역복발화원처전이적위험인소;ECE시영향유선암환자무전이생존시간、무국부혹구역복발생존시간급총생존시간적위험인소.
Objective To study the clinical significance of extracapsular extension (ECE) of axillary lymph node metastases in breast cancer.Methods The clinicopathological data of 1230 cases of nodal positive breast cancer treated in our department from 1989 to 1995 were analyzed retrospectively.Results 486 (39.5%) from the 1230 cases were ECE positive.There was a higher incidence of ECE in postmenopausal women than premenopausal ones (47.5% versus 35.5%,respectively,P＜0.001).The patients in ECE posotive group had a larger tumor size (5.11±2.53 cm versus 3.90±1.80 cm,P＜0.001).18.3% of patients with stage T1 were ECE positive,stage T2 were 36.4%,and stage T3 were 54.4%,and the difference was significant(P＜0.001).ECE was corelated with the number of positive axillary lymph nodes.The ECE positive group had more positive nodes than ECE negative group (16.96±12.16 versus 5.24±6.60,P＜0.001).6.1% of patients with 1 positive node were ECE positive,13.5% with 2-3,35.8% with 4-9,62.3% with 10-19,and 84.0% with more than 20 positive axillary nodes,and there was a significant difference among those groups (P＜0.001 ).ECE had no association with ER/PR status (P=0.706).ECE was a risk factor of local-regional recurrence,but the relapse time had no significant difference (P=0.559).ECE was also a risk factor of distant metastasis,and the relapse time had a significant difference (P＜0.001).The median metastasis free time was 30.0 (2～172) months in ECE positive group,while 37.5 (2～170) months in ECE negative group (P=0.006).CE occurred in 60.4% of the patients with firstly diagnosed bone,skin and distant lymph node metastasis,but in 42.0% of the patients with firstly diagnosed visceral metastasis (P=0.001).The metastasis-free survival rate,locoregional recurrence-free survival rate and overall survival rate of the ECE positive group were much shorter than that of the ECE negative group.COX proportional hazard regression single factor analysis and multi-factor analysis suggested that ECE is an independent factor of metastasis-free survival,locoregional free recurrence and overall survival.Conclusion The presence of ECE in breast cancer is positively related with tumor size and the number of positive lymph nodes.It is also a risk factor of locoregional recurrence and distant metastasis.ECE positive group has a much shorter metastasis-free survival,locoregional recurrencefree survival and overall survival.ECE is a risk factor of those three indexes.