1～2枚前哨淋巴结阳性乳腺浸润性导管癌患者非前哨淋巴结状况分析

Non-sentinel lymph node metastasis in breast invasive ductal carcinoma patients with 1-2 positive sentinel lymph nodes

目的分析有1~2枚前哨淋巴结(SLN)阳性的乳腺癌患者的非前哨淋巴结(NSLN)状况。方法本前瞻性研究纳入2010年1月到2015年10月第三军医大学西南医院乳腺外科收治的乳腺浸润性导管癌220例,行前哨淋巴结活组织检查(SLNB)证实1~2枚SLN阳性后均行乳腺癌改良根治术。术后病理分析NSLN的情况。分析患者分子分型、原发灶分级、是否行新辅助化疗及ER、PR、HER-2、Ki67表达与NSLN阳性的关系用χ~2检验,分析年龄与NSLN阳性的关系用非参数检验。结果 NSLN阳性91例,占41.4%(91/220),其中90例为腋窝Ⅰ水平淋巴结阳性,仅1例同时有Ⅰ、Ⅱ水平淋巴结阳性;NSLN阴性129例,占58.6%(129/220)。患者的分子分型、原发灶分级、是否新辅助化疗、ER、PR、Ki67表达及年龄与NSLN阳性无关(χ~2=1.830、1.336、0.918、0.074、0.000、1.766,Z=-1.369;P=0.608、0.248、0.338、0.786、0.986、0.184、0.171)。在57例HER-2阳性患者中,NSLN阳性30例,阳性率为52.6%;在163例HER-2阴性患者中,NSLN阳性61例,阳性率为37.4%。HER-2阳性患者的NSLN阳性率高于HER-2阴性患者(χ~2=4.027,P=0.045)。结论 1~2枚SLN阳性的乳腺浸润性导管癌患者仍然存在较高的NSLN阳性风险,尤其HER-2阳性的患者更易出现NSLN阳性。

Objective To analyze the metastasis of non-sentinel lymph node （NSLN） in breast invasive ductal carcinoma patients with 1- 2 positive sentinel lymph nodes （SLNs）. Methods A total of 220 patients with breast invasive ductal carcinoma in the Department of Breast Surgery, Southwest Hospital, Third Military Medical University from January 2010 to October 2015 were enrolled in this prospective study. All patients underwent sentinel lymph node biospy （SLNB）, which confirmed the metastases of 1 to 2 SLNs, and then they underwent radical mastectomy. NSLN metastases were pathologically analyzed after operation. The relationship between NSLN metastases and molecular subtypes, staging of primary lesions, neoadjuvant chemotherapy, ER, PR, HER-2 and Ki67 expression was analyzed by χ2 test. The relationship between NSLN metastases and patients＇ age was analyzed by nonparametric test. Results Totally 91 cases （91.4% , 91/220） had positive NSLN, of which 90 cases had axillary lymph node metastasis in level I , and only 1 case had axillary lymph node metastasis in both level I and II. A total of 129 cases were NSLN negative, accounting for 58.6% （129/220）. The molecular subtypes, staging of primary lesions, neoadjuvant chemotherapy, ER, PR and Ki67 expression and patient＇s age showed no significant effect on NSLN metastasis （ χ2 = 1. 830, 1. 336, 0.918,0.074,0.000, 1.766, Z=-1.369; P=0.608,0.248,0.338,0.786,0.986,0.184,0.171）. In 57 HER-2 positive patients, 30 were NSLN positive, with the positive rate of 52. 6%. In 163 HER-2 negative patients, 61 were NSLN positive, with the positive rate of 37.4%. The positive rate of NSLN in HER-2 positive patients was significantly higher than that in HER-2 negative patients （ χ2 = 4. 027, P = 0. 045 ）. Conclusion The breast invasive ductal carcinoma patients with 1 to 2 positive SLNs are in high risk of NSLN metastasis, especially in patients with HER-2 positive.