Objective: To investigate the significance of extranodal extension of axillary lymph nodes (ALN-ENE) metastases in post-operative primary invasive breast carcinoma of non-specific type. Methods: Six hundred and thirty-eight invasive breast cancer cases confirmed by postoperative pathological examination were collected from January 2006 to December 2008. The relationship of lymph node metastases and ALN-ENE with other lymph node parameters and patient outcome was analyzed. Results: Among 638 cases, 263 (41.2%) showed axillary lymph node metastases. ALN-ENE was present in 91 cases (36.4%). The rate of ALN-ENE increased with pT stage and tumor size. Five-year recurrence-free survival rate (RFS) and 5-year overall survival rate (OS) was 86.6% and 91.2% respectively for ALN-ENE positive group, and both were lower than ALN-ENE negative group (P<0.01). One hundred and forty-nine patients with 1 to 3 positive lymph nodes had a 5-year RFS of 91.9%, and 5-year OS of 92.3%, less than ALN-ENE negative group (P<0.01). Univariate analysis showed ALN-ENE positively correlated with lymph node metastasis. Multivariate analysis suggested that ENE was associated with increased recurrence risk and shortened recurrence-free and overall survival, especially in patients with 1 to 3 positive lymph nodes; and it was an independent prognostic factor (P<0.01). Conclusions: The number of lymph nodes metastases is an important predictor of survival in breast cancer patients. ALN-ENE is an independent risk indicator for recurrence and overall survival. For patients with 1 to 3 metastatic axillary lymph nodes, ALN-ENE could alter the patient's clinical pathologic staging, and therefore it is an independent prognostic factor.
目的： 探讨腋窝淋巴结结外侵犯(extranodal extension of axillary lymph nodes，ALN－ENE)对原发性浸润性乳腺癌术后淋巴结转移患者预后的影响。 方法： 回顾性分析河北医科大学第四医院2006年1月至2008年12月间确诊为原发性非特殊型浸润性乳腺癌患者638例，观察淋巴结转移及ALN－ENE情况，并分析其与患者临床病理特征及预后的关系。 结果： 638例患者中，263例(41.2%)存在淋巴结转移，其中91例(34.6%)存在ALN－ENE。随着肿瘤大小、淋巴结转移个数、淋巴结转移率的增加，ALN－ENE发生率升高(均P<0.05)。ALN－ENE阳性组患者5年无复发生存率(RFS)为86.6%，5年总生存率(OS)为91.2%，较ALN－ENE阴性组明显降低，差异有统计学意义(P<0.01)。149例淋巴结转移个数≤3枚，ALN－ENE阳性组患者5年RFS为91.9%、5年OS为92.3%，较阴性组明显降低，差异有统计学意义(P<0.01)。多因素生存分析结果显示，淋巴结转移个数及发生ALN－ENE是影响患者RFS及OS的独立危险因素(P<0.05)，对于淋巴家转移≤3枚患者，ALN－ENE是影响RFS及OS的独立危险因素(P<0.01)。 结论： 腋窝淋巴结转移个数仍然是影响乳腺癌患者预后的重要因素之一，而ALN－ENE是一个预测乳腺癌患者复发风险和生存期的独立指标之一，对于≤3枚淋巴结转移的患者，ALN－ENE有可能改变患者的临床病理分期，是判断该组患者预后的独立指标。.
Keywords: Breast neoplasms; Lymphatic metastasis; Prognosis.