前哨淋巴结阳性个数与早期乳腺癌非前哨淋巴结转移的相关性分析

Correlation between the number of positive sentinel lymph nodes and non-sentinel lymph node metastasis in early breast cancer

目的:前哨淋巴结(SLN)的状态明显影响腋窝淋巴结清扫(ALND)。该研究的目的是分析前哨淋巴结阳性个数与早期乳腺癌非前哨淋巴结转移(NSLN)的相关性。方法:回顾性分析天津医科大学肿瘤医院2014年1月-2017年12月收治的符合Z0011试验纳入标准(cT1-2N0)的SLN阳性且行腋窝淋巴结清扫的早期浸润性乳腺癌,对与NSLN转移相关的变量进行单因素及多因素Logistic回归分析。结果:根据纳入和排除标准,495例患者纳入研究,174例(35.2%)发生NSLN转移;单因素分析显示SLN阳性个数≥3(P<0.000)、受体状态(P=0.007)和淋巴血管侵犯(P=0.006)与NSLN转移相关;多因素分析显示SLN阳性个数≥3是NSLN转移的最重要的独立预测因子(OR=6.604;95%CI3.451~12.638;P<0.000)。对于0、1、2或3个相关的危险因素的患者,NSLN转移率分别为16.4%、23.1%、39.1%和60.7%。结论:SLN阳性个数、受体状态和脉管浸润与NSLN转移相关。SLN阳性个数≥3是NSLN转移最重要的独立预测因素。当存在2或3个危险因素时,NSLN转移率高于ACOSOGZ0011试验的27.3%,强烈建议行ALND。

Objective: To perform the state of sentinel lymph nodes (SLN) affects whether axillary lymph node dissection (ALND) and to analyze the correlation between the number of positive sentinel lymph nodes and non-sentinel lymph node metastasis in early breast cancer. Methods:Data were extracted from the retrospective database of Tianjin Medical University Cancer Hospital from January 2014 to December 2017. Patients who met Z0011 trial inclusion criteria of cT1-2N0 invasive breast cancer in SLN-positive with ALND were recruited. Univariate and multivariate Logistic regression analysis was performed on variables related to NSLN metastasis. Results: According to the inclusion and exclusion criteria, a total of 495 cases were analyzed in univariate and multivariate analysis. The study revealed 174(35.2%) patients were with NSLN metastasis;≥3positive SLN metastases(P<0.000), receptor status(P=0.007), and lymph-vascular invasion(P=0.006) were associated with NSLN metastases. Multivariate analysis revealed that ≥3 positive SLN metastases was the most important independent predictor for NSLN metastases(OR=6.604, 95%CI 3.451~12.638, P<0.000). For patients with different risk factors, the NSLN metastatic rates were 16.4%, 23.1%, 39.1%, and 60.7%, respectively. Conclusion: The number of positive NSLNs, receptor status, and lymph-vascular invasion were correlated with NSLN metastasis. The ≥3 positive SLNs may be an independent predictor for NSLN metastasis. When risk factors 2 or 3 are present, ALND is strongly recommended due to higher than ACOSOG Z0011 trial (27.3%).