淋巴结状况对三阴性乳腺癌临床结局的影响：SEER18数据库人群研究

　　三阴性乳腺癌是一种预后不佳的侵袭性恶性肿瘤。

　　2016年5月18日，美国《肿瘤标靶》杂志在线发表福建医科大学附属协和医院宋传贵、复旦大学附属肿瘤医院邵志敏和江一舟等学者的研究报告，根据2010～2012年监测、流行病学数据和最终结果（SEER）数据库确定了10771例三阴性乳腺癌，并评估了淋巴结状况对乳腺癌特异性生存和总生存的影响。

　　在该研究中，根据生存分析曲线显示，淋巴结阴性（N0）患者比淋巴结阳性患者有较好的生存结局；阳性淋巴结≥10（N3）的患者生存结局最差，无论肿瘤大小。配对比较显示，以肿瘤大小分层各组生存结局无差异。此外，对于肿瘤大小≤2厘米（T1）或＞5厘米（T3）的淋巴结阳性患者，淋巴结1～3（N1）与淋巴结4～9（N2）的患者相似，而N1患者比N3患者有显著较好的生存结局（P＜0.001）。因此，10枚转移性淋巴结是不良预后的临界值。然而，对于肿瘤大小2～5厘米（T2）的患者，淋巴结影响程度对总生存有预后价值，对乳腺癌特异性生存则无。

　　因此，淋巴结状况、肿瘤大小对预测三阴性乳腺癌结局显示不同的相互影响模式。这些研究结果有助于深入了解淋巴结状况对三阴性乳腺癌的预后价值。

Oncotarget. 2016 May 18. [Epub ahead of print]

Effect of nodal status on clinical outcomes of triple-negative breast cancer: a population-based study using the SEER 18 database.

Wang XX, Jiang YZ, Li JJ, Song CG, Shao ZM.

Affiliated Union Hospital, Fujian Medical University, Fuzhou, China; Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.

Triple-negative breast cancer (TNBC) is an aggressive malignancy with a poor prognosis. Data from the Surveillance, Epidemiology and End Results database (2010-2012) were used to identify 10,771 patients with TNBC, and we assessed the effects of lymph node (LN) status on breast cancer-specific survival (BCSS) and overall survival (OS). In our study, a Kaplan-Meier plot showed that LN-negative patients (N0) had better survival outcomes than LN-positive patients and that patients with ≥10 positive LNs (N3) exhibited the worst survival outcomes regardless of tumor size. A pairwise comparison showed no difference in survival outcomes among each group stratified by tumor size. Further, for LN-positive patients with a tumor size ≤2 cm (T1) or >5 cm (T3), there were similar outcomes between patients with one to three LNs (N1) and those with four to nine LNs (N2), whereas N1 patients experienced significantly better survival outcomes than N3 patients (P<0.001). Therefore, ten metastatic lymph nodes was the cut-off value for poor prognosis. Nevertheless, for patients with a tumor size of 2-5 cm (T2), the extent of LN involvement contributed prognostic value to OS but not BCSS. In summary, we found that nodal status and tumor size exhibited distinct interaction patterns for predicting the outcomes of TNBC. These results provide deeper insight into the prognostic value of nodal status in TNBC.

KEYWORDS: breast cancer-specific survival; nodal status; overall survival; triple-negative breast cancer; tumor size

PMID: 27203673

DOI: 10.18632/oncotarget.9432