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根据肿瘤—淋巴结—转移(TNM)为主要因素而确定的分期法,是评价乳腺癌患者预后传统方法,也仍然是临床上最广泛使用的方法。区域淋巴结转移,是证实癌的转移能力和提示潜在可治愈的最有预测性的证据。腋窝淋巴结阴性(Axillary Node—neganve,ANN)患者虽有较好的预后,但经首次手术治疗后,十年内仍有20％～25％因局部复发和远处转移而失败。病期相同的患者,其预后发展可能相差甚远,辅助性化疗和内分泌治疗虽然使得ANN患者中可能失败的少数获益,但绝大多数要接受不必要的治疗,承受由此引起的急慢性毒副作用,甚至会发生第二肿瘤的可能。在Ⅰ期乳腺癌患者中找出20％～25％可能失败的患者,并进行有预见性、针对性的治疗,是学者们一直所期望的,并对此进行了大量研究、分析和比较。本文综述了这方面的一些报道,并从临床角度提出,对ANN病人以肿瘤大小—淋巴结微小转移—病理类型及组织学分级—年龄为主要因素判断预后,作为辅助性治疗的指标。
The staging method, which is based on tumor-lymph node-metastasis (TNM) as the main factor, is a traditional method for evaluating the prognosis of breast cancer patients, and it is still the most widely used method in clinical practice. Regional lymph node metastases are the most predictive evidence of metastatic potential and suggestive of potential cure. Although Axillary node-negative (ANN) patients have a good prognosis, after the first surgical treatment, 20% to 25% of them failed within 10 years because of local recurrence and distant metastasis. In patients with the same disease period, the prognosis may be very different. Although adjuvant chemotherapy and endocrine therapy may make a small number of patients who may fail in ANN benefit, the vast majority need to receive unnecessary treatment to withstand the acute and chronic diseases caused by it. With toxic side effects, even a second tumor may occur. Finding 20% to 25% of patients with stage I breast cancer that may fail, and performing predictive and targeted treatment, is what scholars have been expecting, and has conducted extensive research, analysis and comparison. This article summarizes some reports in this regard, and from the clinical point of view, ANN patients with tumor size - lymph node micrometastases - histological type and histological grade - age as the main factor to determine the prognosis as an indicator of adjuvant therapy.