摘要：据7月27日刊《美国医学会杂志》上的一则研究披露，在接受了乳房保留治疗的罹患早期乳腺癌的妇女中，用免疫组织化学染色的诊断程序所探测到的前哨淋巴结转移与总体存活率之间没有相关性。
根据文章的背景资料：“前哨淋巴结（SLN）清扫通过微创性的腋部淋巴结分期以及对SLN进行更为彻底的检查而使得早期乳腺癌的诊断方法发生了彻底的改变。这一程序使得人们可以探查到癌症的微观转移以及意义不明的孤立肿瘤细胞。对SLNs以及骨髓进行免疫化学染色可发现用常规病理学或临床检查无法看到的乳腺癌转移。”
加州圣塔莫尼卡圣约翰健康中心的前约翰-韦恩癌症研究所的Armando E. Giuliano, M.D.（现在属于洛杉矶Cedars-Sinai 医疗中心）及其同事开展了一项观察研究以检查罹患早期乳腺癌病人的存活率和对其SLNs及骨髓样本用免疫化学染色所探测到的肿瘤转移之间的关系。该研究包括来自临床T1 至 T2N0M0浸润性乳腺癌妇女的数据；这些患者是在1999年5月至2003年5月间参加在126个地点进行的美国外科医师学会肿瘤组Z0010的试验的。所有5210位患者都接受了乳房保留手术和SLN清扫。
对所有这些妇女的随访一直持续到了2010年4月21日。在中位数（中点）为6.3年的跟踪随访中，有435人死亡，376人出现癌症复发。研究人员发现，在那些SLNs苏木精和伊红染色阴性的病人中，隐性转移的免疫化学证据与病人的死亡或疾病复发之间没有显著的关联性。
文章的作者写道，Z0010试验的发现对临床实践具有重要的含意。 “许多实验室常规性地对苏木精和伊红染色呈阴性的SLNs进行多次切片和免疫组织化学染色，尽管美国病理学家学会对SLN处理的指导方针中并不包括对它们的使用。来自Z0010 的数据显示，由免疫组织化学所探查到的隐性转移与最早期乳腺癌患者的存活率差异之间没有关系。尽管更长时间的跟踪可能会揭露结果上的细小差别，但这些差别可能会像National Surgical Adjuvant Breast and Bowel Project B-32试验的发现所展示的那样不具有临床意义。”
“就早期（临床T1-T2N0分期）乳腺癌来说，对苏木精和伊红染色呈阴性的SLNs做常规的免疫组织化学检查和骨髓的常规免疫细胞化学检查是没有临床根据的。 ”
生物探索推荐英文论文摘要：
Association of Occult Metastases in Sentinel Lymph Nodes and Bone Marrow With Survival Among Women With Early-Stage Invasive Breast Cancer
ABSTRACT
Context Immunochemical staining of sentinel lymph nodes (SLNs) and bone marrow identifies breast cancer metastases not seen with routine pathological or clinical examination.
Objective To determine the association between survival and metastases detected by immunochemical staining of SLNs and bone marrow specimens from patients with early-stage breast cancer.
Design, Setting, and Patients From May 1999 to May 2003, 126 sites in the American College of Surgeons Oncology Group Z0010 trial enrolled women with clinical T1 to T2N0M0 invasive breast carcinoma in a prospective observational study.
Interventions All 5210 patients underwent breast-conserving surgery and SLN dissection. Bone marrow aspiration at the time of operation was initially optional and subsequently mandatory (March 2001). Sentinel lymph node specimens (hematoxylin-eosin negative) and bone marrow specimens were sent to a central laboratory for immunochemical staining; treating clinicians were blinded to results.
Main Outcome Measures Overall survival (primary end point) and disease-free survival (a secondary end point).
Results Of 5119 SLN specimens (98.3%), 3904 (76.3%) were tumor-negative by hematoxylin-eosin staining. Of 3326 SLN specimens examined by immunohistochemistry, 349 (10.5%) were positive for tumor. Of 3413 bone marrow specimens examined by immunocytochemistry, 104 (3.0%) were positive for tumors. At a median follow-up of 6.3 years (through April 2010), 435 patients had died and 376 had disease recurrence. Immunohistochemical evidence of SLN metastases was not significantly associated with overall survival (5-year rates: 95.7%; 95% confidence interval [CI], 95.0%-96.5% for immunohistochemical negative and 95.1%; 95% CI, 92.7%-97.5% for immunohistochemical positive disease; P = .64; unadjusted hazard ratio [HR], 0.90; 95% CI, 0.59-1.39; P = .64). Bone marrow metastases were associated with decreased overall survival (unadjusted HR for mortality, 1.94; 95% CI, 1.02-3.67; P = .04), but neither immunohistochemical evidence of tumor in SLNs (adjusted HR, 0.88; 95% CI, 0.45-1.71; P = .70) nor immunocytochemical evidence of tumor in bone marrow (adjusted HR, 1.83; 95% CI, 0.79-4.26; P = .15) was statistically significant on multivariable analysis.
Conclusion Among women receiving breast-conserving therapy and SLN dissection, immunohistochemical evidence of SLN metastasis was not associated with overall survival over a median of 6.3 years, whereas occult bone marrow metastasis, although rare, was associated with decreased survival.
Trial Registration clinicaltrials.gov Identifier: NCT00003854
KEYWORDS: bone marrow neoplasms, breast neoplasms, immunohistochemistry, neoplasm metastasis, sentinel lymph node biopsy, survival, women's health.
