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编者按：乳腺癌多发生于乳房上半部，约占50%以上，其中又以上半部外侧（外上象限）最多，与乳房外上象限的腺叶较多相关。乳房外上象限接近腋窝的部位被称为腋尾，又被以英国女王特命御用苏格兰普通外科医师、爱丁堡大学外科系主任、爱丁堡皇家外科医师学院院长詹姆士·斯宾塞（James Spence）命名。有关腋尾癌的研究较少，其临床病理特征和预后特点尚不明确。 2018年5月，英国德孚《癌症管理与研究》正式发表复旦大学附属肿瘤医院、肿瘤研究所、上海医学院、生物医学研究院的大数据分析报告，对腋尾癌与外上象限乳腺癌的生存结局进行了比较。 该研究通过美国国家癌症研究所的生存监测流行病学最终结果（SEER）数据库，对14万6343例外上象限乳腺癌、2683例腋尾癌患者（中位随访时间88个月）进行分析。主要和次要结局分别为乳腺癌相关生存和总生存；通过竞争风险分析、对数秩检验、多因素比例风险回归模型、倾向评分匹配法，对外上象限乳腺癌与腋尾癌的生存结局进行比较；通过多因素逻辑回归，分析腋尾癌与淋巴结转移的相关性。 结果，腋尾癌与外上象限乳腺癌相比：
多因素比例风险回归模型分析表明，腋尾癌与外上象限乳腺癌相比：
竞争风险分析和对数秩检验表明，按1∶1配对队列的腋尾癌与外上象限乳腺癌相比：
亚组分析表明，腋尾癌淋巴结转移亚组和激素受体阴性亚组的结局较差。多因素逻辑回归分析表明，腋尾癌是影响淋巴结转移的独立因素。 因此，腋尾癌有不同的临床病理特征，较可能与淋巴结转移相关。腋尾癌与外上象限乳腺癌相比，乳腺癌相关生存结局不佳。 Cancer Manag Res. 2018 May;10:1133-1141. Decreased survival in patients with carcinoma of axillary tail versus upper outer quadrant breast cancers: a SEER population-based study. Gou ZC, Liu XY, Xiao Y, Zhao S, Jiang YZ, Shao ZM. Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Institutes of Biomedical Sciences, Fudan University, Shanghai, China. BACKGROUND: Carcinoma of the axillary tail of Spence (CATS) is a poorly studied type of breast cancer. The clinicopathological characteristics and prognostic features of CATS are unclear. METHODS: Using the Surveillance, Epidemiology, and End Results database, we identified 149,026 patients diagnosed with upper outer quadrant breast cancer (UOBC) (n=146,343) or CATS (n=2,683). The median follow-up was 88 months. The primary and secondary outcomes were breast cancer-specific survival (BCSS) and overall survival. The survival outcomes of UOBC and CATS were compared using competing risks analysis, log-rank test, Cox proportional hazards regression model, and propensity score matching method. Multivariate logistic regression was utilized to present the relationship between CATS and lymph node (LN) metastasis. RESULTS: CATS presented a higher grade, higher negative hormone receptor rate, and more positive nodal metastasis. The 10-year BCSS rate was worse for CATS than for UOBC (85.1% vs 87.3%, P=0.001). The multivariate Cox analysis showed a higher hazard ratio (HR) for CATS over UOBC (BCSS: HR =1.20, P=0.001; overall survival: HR =1.11, P=0.019). The difference in the BCSS was also observed in a 1:1 matched cohort (BCSS P=0.019). A subgroup analysis revealed the inferior outcomes of CATS in the metastatic LN subgroup and the hormone receptor-negative subgroup. The multivariate logistic regression indicated that CATS is an independent contributing factor to LN metastasis. CONCLUSION: CATS had distinct clinicopathological characteristics and was more likely associated with LN metastasis. Compared to UOBC, CATS had adverse impacts on BCSS. KEYWORDS: breast cancer-specific survival; carcinoma of the axillary tail of Spence; lymph node metastasis; upper outer quadrant breast cancer PMID: 29795985 PMCID: PMC5958946 DOI: 10.2147/CMAR.S165291
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