中英对照：乳腺癌哨兵淋巴结微小转移需要进一步治疗

ASCO 2009: Sentinel Node Micrometastases Need Additional Treatment in Breast Cancer
美国临床肿瘤学会(ASCO) 2009 : 乳腺癌哨兵淋巴结微小转移需要进一步治疗
Nick Mulcahy
Authors and Disclosures
June 4, 2009 (Orlando, Florida) — Don't ignore micrometastases.
2009/6/4 (Orlando, Florida) – 不要忽视微小转移
That is the main message from a Dutch study of women with early-stage breast cancer presented here at the American Society of Clinical Oncology (ASCO) 45th Annual Meeting.
以上是第45届美国临床肿瘤协会(ASCO)的年会上介绍的一项荷兰研究成果，这是一项针对女性早期乳腺癌患者的研究。

One of the groups of women studied had micrometastases (nodal disease that measures 0.2 to 2.0 mm) discovered by sentinel lymph node biopsy (SLNB).
该研究的研究对象是一组经哨兵淋巴结活检（SLNB）发现具有微小转移（0.2-2.0 mm）的乳癌女性患者
These women had a significantly higher rate of recurrence in the axillary nodes if they did not receive follow-up treatment, according to study results.
研究显示：如果不接受后续的治疗，这些患者腋下淋巴结内肿瘤的复发率将显著升高。

Follow-up treatment was either completion axillary lymph node dissection (cALND) or, less commonly, axillary radiation.
后续治疗是指接受腋窝淋巴结全部切除术（cALND），或者也可以采取非常规的腋窝放疗。
After 5 years, there was a 5% rate of axillary recurrence for the women with micrometastases who only had a SLNB (n = 141) and no follow-up treatment, compared with a 1% rate for those who had either cALND or radiation (n = 887; hazard ratio, 4.39).
研究发现，5年后，那些在哨兵淋巴结活检（SLNB）中发现有微小转移（n =141），但未接受后续治疗的患者，其腋下淋巴结肿瘤复发率为5%； 而那些接受了腋下淋巴结权且cALND或者腋窝放疗的患者的复发率则为1% （n = 887; 对照死亡风险比〈hazard ratio〉为 4.39）


"This 5-year recurrence rate is much too high. And it will likely increase with longer follow-up," said lead author Vivianne Tjan-Heijnen, MD, PhD, at a meeting press conference. She is professor of medical oncology at the Maastricht University Medical Center in the Netherlands.
研究小组的领导者Vivianne Tjan-Heijnen博士在会议的新闻发布会上表示：“这样的5年复发率实在是太高了，因此应该增加后续治疗时间。”她本人是荷兰Maastricht大学医学院的肿瘤系教授。
The new Dutch study, dubbed MIRROR (Micrometastases and Isolated Tumor Cells: Relevant and Robust or Rubbish?), conflicts with a recent large American study. The latter found that follow-up treatment with cALND did not improve either axillary recurrence or survival for patients with microscopic disease, as reported by Medscape Oncology. The senior author of the American study said: "We have relied upon [cALND] too much."
荷兰的这一研究成果被翻译后发表在被《MIRROR》上（文章题目为：《微小转移和孤立的癌细胞：有联系？强烈支持？抑或无稽之谈？》），此项研究成果与美国近年来的一项大规模研究成果有冲突。近年来，研究发现：对有微小转移的患者采取cALND的后续治疗既没有改善腋下淋巴转移，也没有提高患者的生存率，以上观点曾在Medscape Oncology上有所报道。美国的研究者表示：“我们太过于依赖cALND这种治疗方法了。”

However, Dr. Tjan-Heijnen told Medscape Oncology that there are a number of important differences between her study and the American study, all of which strengthen the authority of her group's findings.
然而Tjan-Heijnen博士对Medscape Oncology的采访者指出，她们的研究与美方的研究存在很多重要的区别，这也正是支持她们的研究成果的依据。

She also noted that ASCO guidelines support her findings. "Completion axillary lymph node dissection is recommended in patients with micrometastases," she said, acknowledging that the procedure is associated with an increased rate of lymphedema.
她还强调ASCO的指导思想支持她的理论，她认为，“腋窝淋巴结清扫术适用于有微小转移的患者”，但应当承认，这一治疗过程会提高淋巴水肿的发生率。


An American breast cancer expert attending the meeting felt swayed by the Dutch findings. "We might have to be more aggressive with micrometastases — they should not be ignored," Julie Gralow, MD, told Medscape Oncology. Dr. Gralow is a member of the Fred Hutchinson Cancer Research Cancer in Seattle, Washington, and serves on the ASCO Communications Committee.
一位与会的美国乳癌专家对荷兰的研究成果表示了不同的见解。“我们很可能对微小转移进行了过为严厉的治疗----当然它们也不应该被忽视，”Julie Gralow博士对Medscape Oncology的记者这样说，他本人是西雅图Fred Hutchinson 癌症研究中心的成员，同时也为ASCO的交流委员会工作。

"We have struggled with what to do with micrometastases," observed Dr. Gralow. "Should we avoid further surgery and use radiation? It's important to know that axillary radiation is separate from breast radiation and also produces lymphedema," she added, noting that the standard of care in this situation has been cALND, but clinical judgment comes into play.
“我们在如何治疗微小转移的问题上挣扎着,”Gralow博士说道。“我们应该避免后续手术治疗或者放疗吗？重要的是要知道腋窝放疗是和乳腺放疗分开来的,而且还会造成淋巴水肿,”她又补充道，虽然在这种情况下，采取cALND治疗还没有一个标准可依，但临床上的评价已经开始起作用。
In the end, Dr. Gralow was impressed by the new findings: "I am going to use these data with my patients."
最后，Gralow博士对新理论也很重视：“我将在治疗我的病人时参考这些数据。”

Another American clinician at the meeting felt similarly. "We have never known exactly how to approach these cases. The MIRROR study helps us have a further educated discussion with our patients," said Jennifer Obel, MD, a medical oncologist from the NorthShore University HealthSystem in Evanston, Illinois, and also a member of the ASCO Communications Committee
另一位与会的美国医生也有同感：“我们总是不能确切地知道该如何对待这样的病例，MIRROR的研究帮助我们与患者可以进行进一步的讨论，”Jennifer Obel表示，她本人是以利诺伊州“NorthShore 大学”保健系统（HealthSystem）的肿瘤医生，也是ASCO交流委员会成员。

Dr. Gralow pointed out that, in early breast cancer, the majority of women can avoid any follow-up treatment because the SLNB is negative.
Gralow指出，大部分早期乳腺癌患者因为SLNB检查结果为阴性，而能够避免后续治疗。
Isolated Tumor Cells and Micrometastatic Disease: The Differences
孤立的肿瘤细胞与微小转移：区别
One of the key differences between the recent American and Dutch studies is that they worked with different definitions of the small amounts of disease that can be found by SLNB.
美国与荷兰的研究的主要区别在于他们对于哨兵淋巴结内肿瘤的微小数量的定义不同。
The difference here is not just an academic matter, it is a key to understanding how to proceed clinically, suggested Dr. Tjan-Heijnen.
这一区别并非只是学术意义上的问题，Tjan-Heijnen.博士认为：这是怎样治疗的关键。

In the Dutch study, the investigation separated microscopic disease into 2 groups: the smaller isolated tumor cells (<0.2 mm) and the larger micrometastases (0.2 to 2.0 mm).
荷兰的研究是将微小肿瘤分为两组：一组较小，为单个细胞（小于0.2mm）,另一组较大，定为微小转移（0.2-2.0mm）
The American study did not separate the 2 classifications because, before 2002, both categories were "lumped together," and thus were analyzed as "microscopic" disease, said Dr. Tjan-Heijnen, explaining that the American study's outcome findings date from before 2002.
美国的研究没有对这两种情况进行分类，而是将这两种“合”在了一起，两者均被视为微小肿瘤，Tjan-Heijnen博士表示。而美国的研究早在2002年前便已经有了成果。
The Dutch findings show that isolated tumor cells and micrometastases produce different outcomes and should not be treated the same way by clinicians.
荷兰的研究表明，孤立的肿瘤细胞和微小转移导致的后果并不相同，因此治疗上不应等同对待。
Specifically, in the Dutch study, after 5 years, patients who were found to have isolated tumor cells by SLNB and who did not subsequently undergo cALND (n = 732) did not have a significantly higher rate of axillary recurrence than similar patients (n = 125) who did undergo cALND (2.3% vs 1.6%).
但值得注意的是，5年后，将荷兰方面发现有孤立肿瘤细胞，但未采取腋窝淋巴清扫术的患者（n=732）与情况类似的，施行了腋窝淋巴清扫术的患者(n=125)比较后，结果发现前者并未出现显著的腋下淋巴结复发（2.3% vs 1.6%）。
In other words, it's okay to not do a follow-up treatment in patients with isolated tumor cells, said Dr. Tjan-Heijnen.
Tjan-Heijnen认为，也就是说，对有孤立的肿瘤细胞的患者可以不采取后续治疗。
，
However, Dr. Tjan-Heijnen qualified this recommendation a bit further: "These patients should have favorable tumor characteristics," she said, explaining that any patient with a grade 3 tumor should have follow-up treatment for any kind of nodal disease.
然而，Tjan-Heijnen博士对这个建议作了进一步评价：“这些患者应该属于更具有肿瘤的倾向性”，因此对于任何一个三期肿瘤患者，任何类型的肿块都有必要进行后续治疗。
The Dutch study found that patients with micrometastases all need follow-up treatment, as noted above.
如上所述，荷兰方面的研究认为，微小转移的患者需要进行后续治疗。

The quality of data in the Dutch study was superior in other ways, said Dr. Tjan-Heijnen. Data used in the American study were obtained from a cancer registry and did not undergo a central pathology review, whereas the Dutch data did undergo a central pathology review. According to Dr. Tjan-Heijnen, the authors of the American study admitted that their data on axillary recurrence were incomplete; the Dutch study had axillary recurrence data for all patients.
Tjan-Heijnen还认为：另外来讲，荷兰方面的数据质量更高，因为美方使用的数据取自癌症患者的记录，且并未参考病理方面的记录，而荷兰的研究则在这一方面有所考虑。据Tjan-Heijnen博士讲，美方也承认他们在数据方面是不完整的，而荷兰方面有全部患者的复发方面的数据。

More About MIRROR
关于MIRROR
The Dutch MIRROR study is the largest cohort study on micrometastases and isolated tumor cells in the sentinel node era, say the study authors.
据研究者称，“荷兰MIRROR”是一项最大规模的针对哨兵淋巴结内微小转移和孤立癌细胞的研究。
"The sentinel node is intensively examined to prevent false negatives," said Dr. Tjan-Heijnen. She also said that this intensity has led to increased detection of micrometastases and isolated tumor cells.
Tjan-Heijnen博士说：“检查哨兵淋巴结主要是为防止出现假阴性”，但她又指出，这一检查也便于集中发现微小转移和孤立的癌细胞。

The study was supported by the Netherlands Organization for Health Research and Development (ZonMw) and the Dutch Breast Cancer Trialists' Group (BOOG). The authors have disclosed no relevant financial relationships.
这项研究得到了Netherlands Organization for Health Research and Development (ZonMw) 和Dutch Breast Cancer Trialists' Group (BOOG)的大力支持，但她没有透露相关的经济关系。