早期乳腺癌前哨淋巴结转移的影响因素分析

Analysis of factors affecting sentind lymph nodal status in early breast cancer patients

目的 探讨早期乳腺癌前哨淋巴结转移的影响因素.方法 回顾性分析2006年1月至2011年12月中国医学科学院肿瘤医院635例乳腺癌前哨淋巴结活检病例.采用Logistic回归分析,观察各项临床病理特征与前哨淋巴结转移的相关性.结果 全组女性,年龄21～91岁,平均（50±12）岁.前哨淋巴结转移率19.7％（125/635）.平均每例获取（3.8±2.3）枚前哨淋巴结.单因素分析显示,年龄、腋窝触及淋巴结、病理类型、肿瘤大小和脉管瘤栓与前哨淋巴结转移相关（P＜0.05）.浸润性导管癌是最常见的病理类型（75.1％,477/635）,并且前哨淋巴结阳性率最高（23.9％,114/477）.多因素分析中,腋窝触及淋巴结[OR=7.90,95％可信区间（CI）2.59 ～24.05]、病理类型（OR =7.23,95％ CI 2.39 ～21.85）、肿瘤大小（OR =2.42,95％CI 1.14 ～5.14）和脉管瘤栓（OR=10.00,95％ CI4.27～23.44）是前哨淋巴结转移的影响因素（P＜0.05）.结论 腋窝触及淋巴结、病理类型、肿瘤大小和脉管瘤栓是预测早期乳腺癌前哨淋巴结转移的因素.

Objective To investigate the factors affecting sentinel lymph nodal status in the early breast cancer patients. Methods A review of breast cancer patients who had a successful sentinel lymph node biopsy at the cancer hospital Chinese academy of medical science between January 2006 and December 2011 was analyzed. Logistic regression analysis was performed to identify the relevance of clinical and pathological features with sentinel lymph node metastases. Results The study group was consisted of 635 female patients with an average of （ 50±12） years in age. Sentinel lymph nodes involved in metastasis were found in 19. 7% （125/635）of patients. The mean number of sentinel lymph node removed by the surgeon was （3.8 ±2. 3 ）. In univariate analysis, variables associated with sentinel lymph nodes metastases in early breast cancer were age, palpable axillary lymph node, tumor type, tumor size and lymphovascular invasion （P 〈 0.05 for all variables）. Invasive ductal carcinoma was the most common tumor type （75. 1%, 477/635） and prone to metastasis （23.9%, 114/477）. In multivariate analysis, variables associated with sentinel lymph nodes metastases were palpable axillary lymph node [ OR = 7. 90, 95% con-fidence interval（CI） 2. 59 - 24. 05 ], tumor type （ OR = 7. 23,95% CI 2. 39 - 21.85 ）, tumor size （ OR = 2. 42, 95 % CI 1. 14 - 5.14 ） and lymphovascular invasion （ OR = 10. 00,95 % CI 4. 27±23.44 ） （ P 〈 0. 05 ）. Conclusion Palpable axillary lymph node, tumor type, tumor size and lymphovascular invasion are risk factors of sentinel lymph node in early breast cancer.