乳腺癌前哨淋巴结转移的危险因素

Risk factors of sentinel lymph node metastasis

目的对乳腺癌接受前哨淋巴结活检的患者进行回顾性研究,探讨乳腺癌不同分子分型与前哨淋巴结转移的关系及影响前哨淋巴结转移的危险因素。方法回顾性分析2017年6月至2020年1月于济宁医学院附属医院乳腺外科接受前哨淋巴结活检的192例乳腺癌患者资料,根据雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)的免疫组织化学结果进行分子分型,分析前哨淋巴结转移的危险因素。结果192例乳腺癌患者中,前哨淋巴结阳性52例,阴性140例;Luminal A型SLN转移率17.2%、Luminal B型SLN转移率36.9%、HER-2过表达型SLN转移率45.5%、三阴型SLN转移率16.7%,4种乳腺癌分子分型SLN转移率存在明显统计学差异(χ^(2)=4.818,P=0.028);单因素分析显示HER-2阳性、肿瘤T分期、脉管癌栓浸润等危险因素对前哨淋巴结转移情况的影响存在统计学差异(P<0.05)。logistic回归分析结果显示脉管癌栓浸润及乳腺癌分子分型均是影响前哨淋巴结转移的独立危险因素;Luminal B型及HER-2过表达型乳腺癌发生前哨淋巴结转移风险均高于Luminal A型,差异有统计学意义。结论Luminal B型及HER-2过表达型乳腺癌患者较Luminal A型发生前哨淋巴结转移的风险更高;有脉管癌栓浸润的乳腺癌患者更容易发生前哨淋巴结转移,其他因素的影响有待进一步证实。

Objective A retrospective study was conducted to investigate the relationship between different molecular types of breast cancer and sentinel lymph node biopsy metastasis,and the risk factors influencing sentinel lymph node metastasis.Methods The data of 192 patients with breast cancer who underwent sentinel lymph node biopsy in the department of breast surgery,Affiliated Hospital of Jining Medical University from June 2017 to January 2020 were retrospectively analyzed.According to the immunohistochemical results of estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(HER-2),the molecular typing was performed to analyze the risk factors of sentinel lymph node metastasis.Results Among 192 breast cancer patients,52 had positive sentinel lymph nodes and 140 had negative sentinel lymph nodes.Luminal A SLN metastasis rate was 17.2%,Luminal B SLN metastasis rate was 36.9%,HER-2 overexpressed SLN metastasis rate was 45.5%,and SLN metastasis rate was 16.7%.Statistical analysis showed that SLN metastasis rate of the four breast cancer molecular types was significantly different(P<0.05).Univariate analysis showed that there were statistically significant differences in the influence of risk factors such as positive HER-2,tumor T stage,and vascular tumor plug infiltration on sentinel lymph node metastasis(P<0.05).There was no statistically significant difference in the influence of age,BMI,tumor profile,histological grade and other factors on sentinel lymph node metastasis(P>0.05).The results of multivariate regression analysis showed that vascular plug infiltration and breast cancer molecular typing were independent risk factors for sentinel lymph node metastasis.Luminal B and HER-2 overexpressed breast cancer had higher risk of sentinel lymph node metastasis than Luminal A,and the difference was statistically significant.Conclusion Patients with Luminal B and HER-2 overexpressed breast cancer have a higher risk of sentinel lymph node metastasis than patients with Luminal A.Patients with breast cancer with vascular plug infiltration are more likely to have sentinel lymph node metastasis,and the influence of other factors needs to be further confirmed.