유방암 환자에서 림프계 침범에 따른 임상병리학적 특성

Abstract

Purpose: Breast cancer is the most common cancer in Korean women and the number of cases is increasing. We have found various histopathological differences in breast cancer and are using this knowledge for treatment. Various factors may help determine the progression of cancer in patients. The expression of lymphovascular invasion, a pathologic factor, denotes a poor prognosis. We analyzed the characteristics of patients showing lymphatic invasion. Methods: Data from 606 patients with breast cancer who underwent surgery between 2006 and 2016 were collected. We analyzed various pathologic factors in patients with or without lymphatic invasion expression. Results: Mean age was 52.0±11.2 years (range 29-83 years) and mean follow-up duration was 57.3 months (range 3−125 months). Pathologically, breast cancer types were invasive ductal carcinoma (552, 91.2%), invasive lobular carcinoma (21, 3.4%), and other pathologies (33, 5.4%). Number of patients in stages I, II, III, and IV were 299 (49.3%), 223 (36.8%), 82 (13.7%), and 2 (0.02%), respectively. Immunohistochemistry revealed 396 (65.3%) estrogen receptor (ER)-positive cases, 287 (47.3%) progesterone receptor (PR)-positive cases, and 139 (22.9%) human epidermal growth factor receptor 2 (HER2)-positive cases. Seven patients had local recurrence and 41 patients had distant metastasis, which included 14 bone, 7 lung, 5 liver, and 15 multiple metastases. Seventeen patients showed lymphatic invasion, while 24 patients were without lymphatic invasion. Significant association was observed between T and N stages and lymphatic invasion (p<0.001). No significant correlation was observed between lymphatic invasion and ER (p=0.073), HER2 (p=0.553). However, there was a significant correlation between lymphatic invasion and PR (p=0.044). Overall survival and disease free survival rates were significantly worse in the presence of lymphatic invasion (p<0.01, 0.011, respectively). Conclusion: Lymphatic invasion was associated with T and N stages, overall survival and disease free survival. More careful observation and treatment strategy is needed, especially in locally advanced breast cancer.