乳腺导管原位癌伴微浸润发生腋窝淋巴结转移的相关因素分析

Risk factor analysis of axillary lymph node metastasis in patients with breast ductal carcinoma in situ with microinvasion

目的探讨乳腺导管原位癌伴微浸润(breast ductal carcinoma in situ withmicroinvasion,DCIS-Mi)患者发生腋窝淋巴结转移的危险因素。方法应用回顾性调查方法收集2000年1月至2008年10月可手术乳腺DCIS-Mi病例共174例,分析有无腋窝淋巴结转移患者的不同分子病理特征,并通过χ2检验、Spearman检验以及Logistic回归分析筛选腋窝淋巴结转移的危险因素。结果 174例DCIS-Mi患者中,有腋窝淋巴结转移者9例(5.17%)。DCIS-Mi病灶中,DCIS级别与腋窝淋巴结转移呈正相关(r=0.262,P=0.000),激素受体状态与腋窝淋巴结转移呈负相关(r=-0.192,P=0.011)。经Logistic回归分析各因素相互调整后,DCIS高级别(OR=37.191,P=0.005)和肿瘤直径≥4.0cm(OR=29.634,P=0.023)是DCIS-Mi病灶发生转移的高危因素。结论在DCIS-Mi患者中,DCIS级别高和肿瘤直径≥4.0cm者容易发生腋窝淋巴结转移,对此类患者进行个体化治疗是必要的。

Objective To study the risk factors of axillary lymph node metastasis in patients with breast ductal carcinoma in situ with microinvasion （DCIS-Mi）. Methods Totally 174 cases of DCIS-Mi from January 2000 to December 2008 were involved for retrospective survey. The molecular pathologic features were compared between the patients with axillary lymph node metastasis and the patients without. The risk factors of axillary lymph node metastasis were screened out by Chi-square test, Spearman test and Logistic regression analysis. Results In 174 eases of DCIS-Mi, 9 （5. 17% ） cases were observed with axillary lymph node metastasis. The tumor grade of DCIS was found to be positively correlated with the risk of axillary lymph node metastasis （ r = 0. 262, P = 0. 000）. Patients with hormone receptor positive had decreased risk of axillary lymph node metastasis （ r = -0. 192, P = 0. 011 ）. After adjusted by various factors in Logistic regression analysis, high grade and tumor diameter ≥ 4. 0 cm were the high risk factors of axillary lymph node metastasis in DCIS-Mi （ OR -- 37. 191, P = 0. 005 ; OR = 29. 634, P = 0. 023, respectively）. Conclusion In DCIS-Mi, high tumor grade and tumor diameter ≥ 4.0 cm were the risk factors of axillary lymph node metastasis. It is necessary to give the individualized treatment for these patients.