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 of risk factors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node

目的 前哨淋巴结活检术（sentinel lymph nodes biopsy,SLNB）已经广泛应用于乳腺癌外科治疗,临床发现部分转移淋巴结仅局限于前哨淋巴结。本研究分析前哨淋巴结（sentinel lymph nodes,SLN）阳性乳腺癌患者非前哨淋巴结（non-sentinel lymph nodes,NSLN）转移的影响因素,从而避免不必要的腋窝淋巴结清除（axillary lymph node dissection,ALND）。方法 回顾性分析聊城市人民医院乳腺外科2013-07-1-2015-06-30SLNB阳性行ALND的77例女性乳腺癌患者临床病理资料,分析NSLN转移的影响因素。结果 在SIN清除个数≥4个的情况下,单因素分析发现阳性SLN≥2个（χ^2=10.109,P=0.01）以及LuminalB型患者（χ^2=6.442,P=0.02）发生NSLN转移的风险高。Logistic回归进行多因素分析发现,阳性SLN≥2个是影响NSLN转移的独立危险因素（OR=207.833,95%CI为1.430-30 201.980,P=0.036）。结论 阳性SLN数和分子亚型是影响NSLN转移的危险因素,阳性SLN≥2个是影响NSLN转移的独立危险因素。

OBJECTIVE Sentinel lymph node dissection （SLND） has been widely used in the treatment of breast cancer patients,but clinical reports have found that some metastatic lymph nodes only limited in sentinel lymph node （SLN） ,so it is importment to analyze the risk factors of non-sentinel lymph node （NSLN）metastasis in breast cancer pa- tients with positive sentinel lymph node and avoid unnecessary axillary lymph node dissection. METHODS Totally 77 female breast cancer patients with sentinel lymph node metastasis underwent axillary lymph node dissection in Liaocheng people＇s Hospital from July 1st 2013 to June 30st 2015 ,the clinical data was collected and the risk factors of non-sentinel lymph node metastasis were analyzed. RESULTS When the number of SLN≥4, in univariate analysis of chi-square test, the number of positive sentinel lymph node and molecular subtype turned out to be the risk factors of non-sentinel lymph node metastasis, positive sentinel lymph node numbers ≥2 （χ^2= 10. 109, P = 0.01） and LuminalB patients （χ^2= 6. 442, P= 0.02） have higher metastatic risk of NSLN. Multivariate stepwise logistic regression showed that the numbers of pos- itive sentinel lymph node≥2 was the independent factors of non-sentinel lymph node metastasis（OR=207. 833,95% CI： 1. 430-30 201. 980, P= 0.036）. CONCLUSION The number of positive sentinel lymph node and molecular subtype turned out to be the risk factors of non-sentinel lymph node metastasis, the numbers of positive sentinel lymph node ≥2 were the independent factor of non-sentinel lymph node metastasis.