临床病理因素预测乳腺癌非前哨淋巴结转移的研究

Studies on clinicopathological factors predicting non-sentinel lymph node metastasis in breast cancer

目的研究临床病理因素预测乳腺癌非前哨淋巴结(NSLN)转移。方法回顾性分析安徽医科大学第一附属医院2014年1月—2016年8月期间行前哨淋巴结活检(SLNB)阳性且继续行腋窝淋巴结清扫(ALND)的早期乳腺癌患者102例,分析NSLN转移的相关临床病理因素。结果 102例患者中NSLN阳性42例,阴性60例。单因素分析结果显示,NSLN转移与原发肿瘤大小(χ~2=9.362=0.002)、阳性前哨淋巴结(SLN)数目(χ~2=7.513,P=0.023)、阴性SLN数目(χ~2=8.963,P=0.003)有关,SLN阳性数哑变量处理后分析显示:与仅1枚阳性淋巴结相比,SLN阳性数为2枚及3枚以上的患者其发生NSLN转移的风险分别增大2.625倍及3.656倍,差异有统计学意义(P<0.05);多因素Logistic回归分析显示:原发肿瘤大小(P=0.020,OR=2.122)、阳性SLN数目(P=0.010,OR=1.660)是NSLN转移的独立危险因素,阴性SLN数目(P=0.004,OR=0.733)是NSLN转移的保护因素。结论对于低转移风险的患者如原发肿瘤<2 cm,检出的阳性SLN数<2枚及阴性SLN数>1枚,配合术后全身系统性治疗如化疗、放疗、内分泌治疗及分子靶向治疗等,可考虑行保腋手术。

Objective To study clinicopathological factors predicting of non-sentinel lymph node( NSLN) metastasis in breast cancer.Methods From January 2014 to August 2016,102 early breast cancer patients with sentinel lymph node( SLN) metastasis who underwent auxiliary lymph node dissection at the First Affiliated Hospital of Anhui Medical University were retrospectively assessed. Results The NSLN was positive in 42 patients and the other 60 patients were negative. The tumor size(χ~2=9. 362,P =0.002),number of metastatic SLNs(χ~2=7. 513,P = 0. 023) and number of negative SLNs(χ~2=8. 963, P = 0. 003) were significantly associated with NSLN metastasis in univariate analysis. By using dummy variable,the risk of tumor metastasis in patients with 2 positive SLNs and more than 2 positive SLNs was respectively greater than patients with I positive SLN( OR = 2. 625,3. 656, all P < 0. 05). The tumor size(P = 0.020, OR = 2.122) and the number of metastatic SLNs(P = 0. 010, OR = 1. 660) remained independently increasing risk for NSLN metastasis in multivariate analysis. However,the number of negative SLNs was a protective factor(P = 0. 004,OR =0. 733).Conclusions Breast conserving surgery is considerable in patients with tumor sizes smaller than 2 cm,the number of metastatic SLNs greater than 2 or negative SLNs greater than 1 and subsequently adjuvant systemic therapy, such as chemotherapy, radiotherapy, endocrine therapy and biological targeted therapy.