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目的分析小肿块多腋窝淋巴结转移(肿块直径≤2 cm、腋窝淋巴结转移≥4个)乳腺癌患者的临床特征和预后。方法1993年1月至2003年12月我院共收治小肿块多腋窝淋巴结转移乳腺癌患者118例,对其临床病理特征、辅助治疗进行分析,以发现相关的预后因素。结果全组患者的5年总生存率为75.0%。腋窝淋巴结转移4～9个及≥10个者的5年生存率分别为89.5%和59.8%(P=0.009),术后化疗患者与未化疗患者的5年生存率分别为82.1%和53.3%(P=0.001),术后内分泌治疗者与未行内分泌治疗者的5年生存率分别为89.2%和61.9%(P=0.001)。单因素Kaplan-Merier生存分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的重要因素。Cox多因素预后分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的独立因素。结论小肿块多腋窝淋巴结转移的乳腺癌患者具有易于转移的趋势,患者预后较差,尤其是腋窝淋巴结转移≥10个的患者;肿瘤分期、辅助化疗和内分泌治疗是影响患者预后的独立因素;合理的综合治疗有可能改善小肿块多腋窝淋巴结转移乳腺癌患者的预后。
Objective To analyze the clinical characteristics and prognosis of breast cancer patients with multi-axillary lymph node metastasis (tumor diameter≤2 cm and axillary lymph node metastasis≥4). Methods From January 1993 to December 2003, a total of 118 patients with multi-axillary lymph node metastasis and breast cancer were treated in our hospital from January 1993 to December 2003. Their clinical and pathological features and adjuvant therapy were analyzed to find out the related prognostic factors. Results The 5-year overall survival of all patients was 75.0%. The 5-year survival rates of 4 to 9 and ≥10 axillary lymph node metastases were 89.5% and 59.8%, respectively (P = 0.009). The 5-year survival rates of patients with and without chemotherapy were 82.1% and 53.3% (P = 0.001). The 5-year survival rate was 89.2% and 61.9% (P = 0.001) for endocrine patients and non-endocrine patients, respectively. Univariate Kaplan-Merier survival analysis showed that tumor staging, postoperative chemotherapy and endocrine therapy are important factors affecting the prognosis of patients. Cox multivariate prognostic analysis showed that tumor staging, postoperative chemotherapy and endocrine therapy are independent prognostic factors. Conclusions The patients with multi-axillary lymph node metastasis in small lumps tend to have a tendency to metastasize. The prognosis is poor, especially in patients with axillary lymph node metastasis ≥10. Staging, adjuvant chemotherapy and endocrine therapy are independent prognostic factors. Reasonable The combination therapy may improve the prognosis of patients with multi-axillary lymph node metastasis in small lumps.