前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的影响因素分析

Analysis on the influencing factors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node

目的探讨腋窝前哨淋巴结(SLN)阳性的乳腺癌患者非前哨淋巴结(nSLN)转移情况与其临床病理特征之间的关系。方法回顾性分析2011年1月-2018年2月吉林大学第二医院乳腺外科64例临床分期为T1-2N0M0期、SLN阳性并行腋窝淋巴结清扫术(ALND)的乳腺癌病人资料,其中28例患者nSLN有转移、36例患者nSLN无转移。应用卡方检验、秩和检验以及多因素Logistic回归分析等统计学方法分析nSLN转移与其临床病理特征的关系。结果在SLN阳性的乳腺癌病人中,56%(36/64)腋窝淋巴结转移仅限于SLN。单因素分析结果显示,nSLN转移与阳性SLN数目、原发肿瘤直径以及神经/脉管等淋巴结外浸润情况有关(Z=-1.991,P=0.047;Z=-2.145,P=0.031;χ^2=5.630,P=0.018);与病理类型、组织学分级、激素受体状态、是否多个病灶、人表皮生长因子受体2(HER-2)以及Ki67表达状况无关。多因素分析显示,原发肿瘤直径、神经/脉管等淋巴结外浸润以及阳性SLN数目均为nSLN转移的独立影响因素(OR=2.700,P=0.006;OR=2.759,P=0.008;OR=1.934,P=0.009)。结论肿瘤直径较大、有神经/脉管等淋巴结外浸润以及阳性SLN数目较多的SLN阳性乳腺癌患者更容易发生nSLN转移。

Objective To explore the correlation between non-sentinel lymph node ( nSLN) metastasis and clinicopathological features of breast cancer patients with positive sentinel lymph node ( SLN) .Methods The clinicopathological data were collected and analyzed retrospectively from 64 patients with clinical stage T1-2N0M0 breast cancer and positive SLN after axillary lymph node dissection ( ALND) in Department of Breast Surgery,the Second Hospital of Jilin University from January 2011 to February 2018,28 patients with nSLN metastasis and 36 patients without nSLN metastasis were included.Chi-square test,Rank sum test,and multivariate Logistic regression analysis were used to analyze the correlation between clinicopathological characteristics of breast cancer and nSLN metastasis.Results Among the breast cancer patients with positive SLN,the metastatic axillary lymph nodes of 36 patients ( 56%) were all SLN.Univariate analysis showed that nSLN metastasis was associated with the number of positive SLN,diameter of primary tumor,and vascular invasion ( Z= -1.991,P= 0.047;Z= -2.145,P = 0.031;χ^2 = 5.630,P = 0.018) ,which was not correlated with pathological type,histological grade,hormone receptor,multiple tumors or not,expressions of Her-2 and Ki67.Multivariate analysis showed that diameter of primary tumor,vascular invasion,and the number of positive SLN were independent influencing factors of nSLN metastasis ( OR= 2.700,P= 0.006;OR= 2.759,P= 0.008;OR= 1.934,P= 0.009) .Conclusion Breast cancer patients with large diameter of primary tumor,vascular invasion,and more quantity of positive SLN are more prone to nSLN metastasis.