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羅喬,王明暘,郭文宏,黃俊升 台大醫院外科部一般外科乳房外科

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Presentation on theme: "羅喬,王明暘,郭文宏,黃俊升 台大醫院外科部一般外科乳房外科"— Presentation transcript:

1 羅喬,王明暘,郭文宏,黃俊升 台大醫院外科部一般外科乳房外科
乳癌AJCC 1B期臨床之應用價值探討: 單一醫學中心研究報告 Is AJCC stage 1B clinical meaningful? survival analysis from a single institution 羅喬,王明暘,郭文宏,黃俊升 台大醫院外科部一般外科乳房外科

2 Staging refers to the grouping of patients according to the extent of their disease.
NTUH yeqr survival rate Staging is useful in determining the choice of treatment, estimating their prognosis.

3 2010 ~ 2014 N=4592 Stage IA, IB, IIA N=2055 Stage IA N=1223 ( 30%)
Stage IB N= 54 ( 1.3%) Stage IIA N=778 (21%) 2010 ~ 2014 N=4592 Stage IA, IB, IIA N=2055 Stage IA N=1223 Stage IB N= 54 Stage IIA N=778

4 American Society of Clinical Oncology and the College of American Pathologists recommend that sentinel lymph nodes (SLNs) be processed in 2.0-mm sections along the long axis and that all sections be subjected to hematoxylin and eosin (HE) staining. Immunohistochemistry (IHC) Identification of occult metastases in 10% to 15% of patients.

5 2002 6th edition AJCC, difinition
macrometastases ( 2.0 mm), micrometastases ( 0.2 mm to 2.0 mm), and isolated tumor cells (ITCs; 0.2 mm) in axillary lymph nodes 7th edition: isolated : <200 cell 6th edition pT1NmiM0 and pT1N1M0 : stage IIA 7th edition pT1Nmi : stage IB

6 6th edition pT1NmiM0 and pT1N1M0 : stage IIA
7th edition pT1Nmi : stage IB 2002 6th edition pT1NmiM0 and pT1N1M0 : stage IIA 2010 7th edition pT1Nmi : stage IB

7 Characteristic Stage IA (n=1223) Stage IB (n=54) Stage IIA (n=778) P*(IA v IB) P*( IB v IIA) No. of patients % Age, years Median Range 52 17-89 51 31-77 53 18-91 0.804 0.471 Histology IDC 1050 85.9% 50 92.6% 645 82.9% 0.161 0.063 ILC 4.1% 47 6.0% 0.130 IDC/ILC 12 1% 1 1.9% 1.5% 0.533 0.859 Other 111 9.1% 3 5.6% 74 9.5% 0.375 0.332 ER status Positive 944 77.2% 42 77.8% 564 72.5% 0.919 0.399 Negative 272 22.2% 13 210 27.0% 0.752 0.640 Unknown 7 0.6% 0% 4 0.5% 0.577 0.597 PR status 762 62.3% 33 61.1% 434 55.8% 0.446 449 36.7% 21 38.9% 338 43.4% 0.746 0.513 6 0.8% 0.465 0.517 HER2 status 298 23.6% 204 26.2% 0.844 0.481 930 76% 574 73.8 % 0.854 0.3% 0.674 . Adjuvant chemotherapy Yes 429 35% 39 72.2% 536 68.9% 0.000  0.609 No 794 65% 15 27.8% 242 31.1% Adjuvant endocrine therapy 914 74.7% 41 75.9% 556 71.5% 308 25.2% 24.1% 222 28.5% 0.1% 0.834 Adjuvant target therapy 154 12.6% 22.3% 165 21.2% 0.040 0.860 1068 87.3% 77.7% 613 78.8% 0.042 Table 1. Clinicopathologic Characteristics of Patients With Stage IA, IB, or IIA Disease in The National Taiwan University Hospital 2010~ 2014 Cohort 2010 ~ 2014 N=4592 Stage IA, IB, IIA N=2055 Stage IA N=1223 Stage IB N= 54 Stage IIA N=778

8 N=2055 P=0.465 HR 95% CI P IA v IB 2.2 0.5-9.7 0.283 IB v IIA 0.7
HR 95% CI P IA v IB 2.2 0.283 IB v IIA 0.7 0.697 IIA v IA 1.2 0.280

9 2010~ 2014 Stage Ib : N= 54 ER (+), Her2/Neu (-): N= 35
C/T : N= 24 (68.6%) Without C/T : N=11 (31.4%) survival difference ? Median 4.7 years (rage, 2.6~7.1 years)

10 P=0.4984

11 Discussion Prognosis Small primary tumor + Small volume metastasis in LN = pathologically node negative In stage Ib , ER (+) Her2/Neu (-) group C/T did not improved overall survival

12 Conclusion In stage Ib , ER (+) Her2/Neu (-) group C/T can be omitted
guide treatment and stratify patients to prognosis Biology >>> anatomy TNM stage 8th edition of AJCC staging -> Ib ?


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