T1期乳腺癌腋窝淋巴结转移及乳腺癌特异生存的影响因素分析

Analysis of factors influencing the axillary lymph node metastasis and breast cancer-specific survival in patients with T1 breast cancer

目的探讨影响T1期乳腺癌患者腋窝淋巴结转移的因素，并分析其乳腺癌特异生存（BCSS）。方法回顾性分析河南省肿瘤医院2009年1月至2014年1月840例T1期浸润性乳腺癌的临床病理资料（T1a、Tlb和T1c患者分别为112例、238例和490例），全组女性。分别用X^2检验和Logistic回归的方法分析影响腋窝淋巴结转移的因素。用Log-rank检验和Cox回归分析影响BCSS的因素。结果840例T1期乳腺癌患者中腋窝淋巴结阳性患者共150例（17．9％）。单因素分析发现肿块大小、组织学分级、肿瘤位置和HER2状态与腋窝淋巴结状态相关（P〈0．05）；多因素分析显示肿块大小、组织学分级、肿瘤位置和HER2状态是腋窝淋巴结转移的独立预测因素（P〈0．05）。Log-rank检验分析显示，肿块大小、组织学分级、HER2状态、PR状态和阳性淋巴结数目是影响淋巴结阳性患者BCSS的重要因素（P〈0．05）。Cox多因素预后分析显示，肿块大小和阳性淋巴结数目是影响淋巴结阳性患者BCSS的独立因素（P〈0．05）。结论肿块大小、组织学分级、肿瘤位置和HER2状态与T1浸润性乳腺癌的腋窝淋巴结状态相关；腋窝淋巴结阳性的T1期乳腺癌，淋巴结转移数目越多，原发肿块越小，预后越差。

Objective To investigate the predictors of axillary lymph node metastasis and the breast cancer-specific survival （BCSS） in patients with T1 breast cancer. Methods A retrospective analysis of clinical and pathological data of 840 T1 invasive breast cancer cases between January 2009 and January 2014 in Henan Cancer Hospital was conducted. Chi square test and Logistic regression analysis were carried out to identify relevant factors of lymph node metastasis. Analysis of prognostic factors were analyzed by Log-rank test and Cox regression. Results Among the 840 T1 breast cancer cases, positive axillary lymph nodes were found in 150 （17.9%） cases. Univariate analysis showed that tumor size, histological grade, tumor location, and HER2 status were associated with axillary lymph node status （ P 〈 0. 05 ）. Multivariate analysis showed that tumor size, histological grade, tumor location, and HER2 status were independent predictive factors of axillary lymph node metastasis （ P 〈 0. 05 ）. Log-rank test showed that tumor size, histological grade, HER2 status, partial response （PR） status and number of positive lymph nodes were important factors influencing BCSS of the patients with positive axillary lymph nodes （ P 〈 0. 05 ）. Cox analysis showed that the size of the primary tumors and the number of positive lymph nodes were independent factors affecting the BCSS of the patients （ P 〈 0. 05 ）. Conclusions Tumor size, histological grade, tumor location and HER2 status correlated with axillary lymph nodes status of T1 breast cancer. For T1 breast cancer patients with positive axillary lymph node, more positive lymph nodes involved and smaller primary tumor correlated with worse prognosis.