• 1. 中國醫(yī)科大學附屬第一醫(yī)院乳腺外科(遼寧沈陽110001);;
  • 2.中國醫(yī)科大學附屬第一醫(yī)院檢驗科(遼寧沈陽110001);

目的探討淋巴結(jié)轉(zhuǎn)移比率（MLNR）在預(yù)測淋巴結(jié)轉(zhuǎn)移乳腺癌患者預(yù)后中的應(yīng)用價值。方法 回顧性分析94例接受改良根治術(shù)治療的淋巴結(jié)轉(zhuǎn)移乳腺癌患者的臨床資料，并對患者生存情況及影響預(yù)后的相關(guān)因素進行分析。結(jié)果 94例患者隨訪時間為12~75個月，中位隨訪時間為64個月，5年生存率為72.34%(68/94)。 總MLNR為0.31（486/1 553）。單因素分析顯示原發(fā)腫瘤大小、淋巴結(jié)轉(zhuǎn)移數(shù)目、ER狀態(tài)、放療與否和MLNR影響淋巴結(jié)轉(zhuǎn)移乳腺癌患者的預(yù)后（P lt;0.05），而患者年齡、絕經(jīng)與否、PR狀態(tài)、內(nèi)分泌治療與否和組織學類型與預(yù)后無關(guān)（P gt;0.05）。多因素分析發(fā)現(xiàn)MLNR（OR=2.565,95%CI=1.043~6.309，P=0.040）和腫瘤大?。∣R=2.220,95%CI=1.045~4.716，P=0.038）是影響淋巴結(jié)轉(zhuǎn)移乳腺癌患者預(yù)后的獨立因素。結(jié)論MLNR是影響淋巴結(jié)轉(zhuǎn)移乳腺癌患者的獨立預(yù)后因素，且其預(yù)測效果比淋巴結(jié)轉(zhuǎn)移數(shù)目更為準確和客觀。

引用本文： 李永峰,吳云飛,張慧. 淋巴結(jié)轉(zhuǎn)移比率在預(yù)測淋巴結(jié)轉(zhuǎn)移乳腺癌患者預(yù)后中的價值. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(7): 750-754. doi: 復(fù)制

1. VinhHung V, Burzykowski T, Cserni G, et al. Functional form of the effect of the numbers of axillary nodes on survival in early breast cancer [J]. Int J Oncol, 2003, 22(3): 679704.
2. VinhHung V, Cserni G, Burzykowski T, et al. Effect of the number of uninvolved nodes on survival in early breast cancer [J]. Oncol Rep, 2003, 10(2): 363368.
3. Woodward WA, Strom EA, Tucker SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stagespecific survival [J]. J Clin Oncol, 2003, 21(17): 32443248.
4. Kuru B. Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma [J]. Eur J Surg Oncol, 2006, 32(10): 10821088.
5. Voordeckers M, VinhHung V, Van de Steene J, et al. The lymph node ratio as prognostic factor in nodepositive breast cancer [J]. Radiother Oncol, 2004, 70(3): 225230.
6. VinhHung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio a an alternative to pN staging in nodepositive breast cancer [J]. J Clin Oncol, 2009, 27(7): 10621068.
7. Van Lancker M, Goor C, Sacre R, et al. Patterns of axillary lymph node metastasis in breast cancer [J]. Am J Clin Oncol, 1995, 18(3): 267272.
8. 廖寧, 王坤, 吳一龍. NCCN乳腺癌臨床指引(2003.2版) [J]. 循證醫(yī)學, 2003, 3(3): 167192.
9. Truong PT, Berthelet E, Lee J, et al. The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes [J]. Cancer, 2005, 103(10): 20062014.
10. 陳先有, 陳玉泉. 乳腺癌改良根治術(shù)中部分腋窩淋巴結(jié)清掃的遠期療效分析 [J].中國普外基礎(chǔ)與臨床雜志, 2009, 16(7): 527530.
11. MartinezRamos D, EscrigSos J, AlcaldeSanchez M, et al. Diseasefree survival and prognostic significance of metastatic lymph node ratio in T1T2 N positive breast cancer patients. A population registrybased study in a European country [J]. World J Surg, 2009, 33(8): 16591664.
12. Rivadeneira DE, Simmons RM, Christos PJ, et al. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients [J]. J Am Coll Surg, 2000, 191(1): 18.
13. Maibenco DC, Weiss LK, Pawlish KS, et al. Axillary lymph node metastases associated with small invasive breast carcinomas [J]. Cancer, 1999, 85(7): 15301536.
14. Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials [J]. J Clin Oncol, 2004; 22(21): 42474254.
15. 孟潔. 年輕乳腺癌發(fā)生及預(yù)后因素篩選研究 [D]. 天津： 天津醫(yī)科大學, 2007: 129.
16. Woodward WA, VinhHung V, Ueno NT, et al. Prognostic value of nodal ratios in nodepositive breast cancer [J]. J Clin Oncol, 2006, 24(18): 29102916.
17. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinellymphnode resection and conventional axillarylymphnode dissection in patients with clinically nodenegative breast cancer: results from the NSABP B32 randomised phase Ⅲ trial [J]. Lancet Oncol, 2007, 8(10): 881888.
18. 申鄭堂, 王守滿, 羅沙陽. 乳腺癌局部進展期新輔助化療后哨兵淋巴結(jié)活檢準確性的臨床觀察 [J]. 中國醫(yī)學工程, 2006, 14(6): 583585, 589.
19. 梁峰, 張宏艷, 陳濟生, 等. 哨兵淋巴結(jié)活檢對乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的預(yù)測 [J]. 中國現(xiàn)代醫(yī)學雜志, 2010, 20(11): 16981700.
20. 鐘穎, 孫強, 徐雅莉, 等. 30年乳腺癌治療趨勢的變化 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(11): 911917.
21. 薛衛(wèi)成, 闞秀. 介紹乳腺癌TNM分期系統(tǒng)(第6版) [J]. 診斷病理學雜志, 2008， 15(3): 161164.
22. Krag DN, Single RM. Breast cancer survival according to number of nodes removed [J]. Ann Surg Oncol, 2003, 10(10): 11521159.
23. van der Wal BC, Butzelaar RMJM, van der Meij S, et al. Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage Ⅰ and Ⅱ breast cancer [J]. Eur J Surg Oncol, 2002, 28(5): 481489.
24. Megale Costa LJ, Soares HP, Gaspar HA, et al. Ratio between positive lymph nodes and total dissected axillary lymph nodes as an independent prognostic factor for diseasefree survival in patients with breast cancer [J]. Am J Clin Oncol, 2004, 27(3): 304306.
25. Hatoum HA, Jamali FR, ElSaghir NS, et al. Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph nodepositive breast cancer [J]. Ann Surg Oncol, 2009, 16(12): 33883395.
26. 梅欣, 郭小毛, 章倩. 乳腺癌術(shù)后腋窩淋巴結(jié)轉(zhuǎn)移對放療的指導意義 [J]. 臨床腫瘤學雜志, 2006, 11(4): 295299.
  1. 1. VinhHung V, Burzykowski T, Cserni G, et al. Functional form of the effect of the numbers of axillary nodes on survival in early breast cancer [J]. Int J Oncol, 2003, 22(3): 679704.
  2. 2. VinhHung V, Cserni G, Burzykowski T, et al. Effect of the number of uninvolved nodes on survival in early breast cancer [J]. Oncol Rep, 2003, 10(2): 363368.
  3. 3. Woodward WA, Strom EA, Tucker SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stagespecific survival [J]. J Clin Oncol, 2003, 21(17): 32443248.
  4. 4. Kuru B. Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma [J]. Eur J Surg Oncol, 2006, 32(10): 10821088.
  5. 5. Voordeckers M, VinhHung V, Van de Steene J, et al. The lymph node ratio as prognostic factor in nodepositive breast cancer [J]. Radiother Oncol, 2004, 70(3): 225230.
  6. 6. VinhHung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio a an alternative to pN staging in nodepositive breast cancer [J]. J Clin Oncol, 2009, 27(7): 10621068.
  7. 7. Van Lancker M, Goor C, Sacre R, et al. Patterns of axillary lymph node metastasis in breast cancer [J]. Am J Clin Oncol, 1995, 18(3): 267272.
  8. 8. 廖寧, 王坤, 吳一龍. NCCN乳腺癌臨床指引(2003.2版) [J]. 循證醫(yī)學, 2003, 3(3): 167192.
  9. 9. Truong PT, Berthelet E, Lee J, et al. The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes [J]. Cancer, 2005, 103(10): 20062014.
  10. 10. 陳先有, 陳玉泉. 乳腺癌改良根治術(shù)中部分腋窩淋巴結(jié)清掃的遠期療效分析 [J].中國普外基礎(chǔ)與臨床雜志, 2009, 16(7): 527530.
  11. 11. MartinezRamos D, EscrigSos J, AlcaldeSanchez M, et al. Diseasefree survival and prognostic significance of metastatic lymph node ratio in T1T2 N positive breast cancer patients. A population registrybased study in a European country [J]. World J Surg, 2009, 33(8): 16591664.
  12. 12. Rivadeneira DE, Simmons RM, Christos PJ, et al. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients [J]. J Am Coll Surg, 2000, 191(1): 18.
  13. 13. Maibenco DC, Weiss LK, Pawlish KS, et al. Axillary lymph node metastases associated with small invasive breast carcinomas [J]. Cancer, 1999, 85(7): 15301536.
  14. 14. Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials [J]. J Clin Oncol, 2004; 22(21): 42474254.
  15. 15. 孟潔. 年輕乳腺癌發(fā)生及預(yù)后因素篩選研究 [D]. 天津： 天津醫(yī)科大學, 2007: 129.
  16. 16. Woodward WA, VinhHung V, Ueno NT, et al. Prognostic value of nodal ratios in nodepositive breast cancer [J]. J Clin Oncol, 2006, 24(18): 29102916.
  17. 17. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinellymphnode resection and conventional axillarylymphnode dissection in patients with clinically nodenegative breast cancer: results from the NSABP B32 randomised phase Ⅲ trial [J]. Lancet Oncol, 2007, 8(10): 881888.
  18. 18. 申鄭堂, 王守滿, 羅沙陽. 乳腺癌局部進展期新輔助化療后哨兵淋巴結(jié)活檢準確性的臨床觀察 [J]. 中國醫(yī)學工程, 2006, 14(6): 583585, 589.
  19. 19. 梁峰, 張宏艷, 陳濟生, 等. 哨兵淋巴結(jié)活檢對乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的預(yù)測 [J]. 中國現(xiàn)代醫(yī)學雜志, 2010, 20(11): 16981700.
  20. 20. 鐘穎, 孫強, 徐雅莉, 等. 30年乳腺癌治療趨勢的變化 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(11): 911917.
  21. 21. 薛衛(wèi)成, 闞秀. 介紹乳腺癌TNM分期系統(tǒng)(第6版) [J]. 診斷病理學雜志, 2008， 15(3): 161164.
  22. 22. Krag DN, Single RM. Breast cancer survival according to number of nodes removed [J]. Ann Surg Oncol, 2003, 10(10): 11521159.
  23. 23. van der Wal BC, Butzelaar RMJM, van der Meij S, et al. Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage Ⅰ and Ⅱ breast cancer [J]. Eur J Surg Oncol, 2002, 28(5): 481489.
  24. 24. Megale Costa LJ, Soares HP, Gaspar HA, et al. Ratio between positive lymph nodes and total dissected axillary lymph nodes as an independent prognostic factor for diseasefree survival in patients with breast cancer [J]. Am J Clin Oncol, 2004, 27(3): 304306.
  25. 25. Hatoum HA, Jamali FR, ElSaghir NS, et al. Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph nodepositive breast cancer [J]. Ann Surg Oncol, 2009, 16(12): 33883395.
  26. 26. 梅欣, 郭小毛, 章倩. 乳腺癌術(shù)后腋窩淋巴結(jié)轉(zhuǎn)移對放療的指導意義 [J]. 臨床腫瘤學雜志, 2006, 11(4): 295299.