不同T分期乳腺癌患者分子分型与腋窝淋巴结转移的关系及其临床意义

Relationship between molecular typing and axillary lymph node metastasis in breast cancer patients with different T stages and its clinical significance

目的：探讨不同肿瘤大小（T）分期乳腺癌患者病理分子分型与腋窝淋巴结转移的关系及其临床意义,指导前哨淋巴结活检术的应用,以避免腋窝淋巴结清扫术带来的术后并发症。方法：回顾性分析本科收治的临床资料完整、首次治疗为手术治疗、T在0~5cm的2 100例乳腺癌患者的临床病理特征及免疫组织化学检测结果,分析不同T分期乳腺癌患者分子分型与腋窝淋巴结转移的关系。比较不同分子亚型乳腺癌患者腋窝淋巴结转移率的差异,并对影响腋窝淋巴结转移的相关因素进行多因素Logistic回归分析。

Objective： To explore the relationship between molecular typing and axillary lymph node metastasis in the breast cancer patients with different tumor size （T） stages and its clinical significance, and to guide the application of sentinel lymph node biopsy to avoid the postoperative complications caused by axillary lymph node dissection. Methods： The clinicopathologic features and immunohistochemistry results of 2 100 breast cancer patients whose clinical data were complete with first treatment of surgical treatment and the T of 0- 5 cm were retrospectively analyzed. The relationship between various molecular subtyping of breast cancer and axillary lymph node metastasis was analyzed. The differences of axillary lymph node metastasis rates between various molecular subtypes were compared. The relevant {actors of axillary lymph node metastasis were analyzed by multivariate Logistic regression analysis. Results, The axillary lymph node metastasis rates among various molecular subtyes had obvious differences when the T of breast cancer were 1 cm〈T≤2 cm, 2 cm〈T≤3 cm, and 3 cm〈T≤4 cm （P〈0.05）. In 0 cm〈T≤1cm, 1cm〈T≤2cm, 2 cm〈T≤3 cm, and 3 cm〈T≤4 cm, Luminal B type had the higher lymph node metastasis rate, and the rates were 40.00%, 29.41%, 50.00M, and 65.22%. When the tumor size was 4 cm〈T≤5 cm, the axillary lymph node metastasis rate of Her-2 type was the highest, about 75%. In all the breast cancer T grouping Triple-negative type had the lowest axillary lymph node metastasis rate. Her-2 overexpression was the independent risk factor for the metastasis of axillary lymph node. Oonclusion~ The characteristics of axillary lymph node metastasis are different in the breast cancer patients with various molecular subtypes. In the patients with Luminal B type and Her-2 type the sentinel lymph node needs to be more cautious. Her-2 overexpression is the independent risk factor for the metastasis of axillary lymph node. Molecular typing is an important complement to the traditional breast cancer pathological type and stage and it can further suggest the biological behavior of breast cancer and contribute to the development of individualized treatment.