乳腺癌Ⅲ水平淋巴结转移的危险因素分析

High risk factors of the third level of lymphatic metastasis in breast cancer patients received radical/modified mastectomy： an analysis of 746 cases

目的 探讨乳腺癌腋窝Ⅲ水平淋巴结转移的高危因素.方法 回顾性分析2001年8月至2011年12月收治的746例乳腺癌根治术或改良根治术行Ⅰ～Ⅲ水平淋巴结清扫患者的临床资料,患者均为女性,年龄33 ～ 80岁,中位年龄46岁.选取11个可能与乳腺癌Ⅲ水平淋巴结转移相关性较大的因素,分析不同情况下Ⅲ水平淋巴结转移的高危因素.结果 腋窝Ⅰ～Ⅱ水平淋巴结移数目（OR =4.541,95％CI：3.569 ～5.776）、肿瘤位置（OR=1.437,95％ CI：1.029～2.007）、淋巴结外浸润（OR =3.809,95％ CI：1.683 ～8.618）、雌激素受体表达阴性（OR =0.740,95％ CI：0.569 ～0.964）是Ⅲ水平淋巴结转移的高危因素.进一步分层分析表明：T3期以上的肿瘤位于外侧时更容易发生腋窝Ⅲ水平淋巴结转移（χ^2外侧比内侧=4.458,P=0.035;χ^2外侧比乳晕区=7.090,P=0.008）,ER表达阴性时随着肿瘤分期的增高更容易发生Ⅲ水平淋巴结转移（χ^2T3比T1=6.133,P=0.013;χ^2T3比T2=5.664,P=0.017）.结论 对于术前乳腺肿瘤穿刺活检证实ER表达阴性的T3期及以上的肿瘤、术中探查疑腋窝Ⅰ～Ⅱ水平淋巴结较多转移或疑伴有淋巴结外组织浸润时,宜积极行腋窝Ⅲ水平淋巴结清扫.

Objective To study the high risk factors of the third level of lymphatic metastasis in breast cancer patients to guide clinical practice. Methods The clinical data of 746 breast cancer patients （ all female, aged from 33 to 80 years with a median of 46 years） received radical or modified mastectomy between 2001 and 2011 was analyzed retrospectively. Eleven individual variables were selected to investigate high risk factors of the third level of lymphatic metastasis in different conditions. Results Axillary nodes metastasis status （ OR = 4. 541,95% CI： 3. 569 - 5. 776）, tumor site （ OR = 1. 437,95% CI： 1. 029 - 2. 007）, external nodes involved （ OR = 3. 809,95% CI： 1. 683 - 8. 618） and estrogen receptor （ OR = 0. 740,95% CI：0. 569- 0. 964） were high risk factors of the third level of lymphatic metastasis. Further analysis found that it is prone to happen a metastasis, especially when the tumor with a size over 5 cm and located at the lateral quadrant. Negative estrogen receptor was a risk factor of the third level lymphatic metastasis along with the tumor stage. Conclusion For preoperative tumor biopsy shows Negative estrogen receptor of tumor stage T3 and over stage 33 when considering suspicious lymph node metastasis or external tissues metastasis introperatively should take in account into third level axillary lymph node dissection actively.