新辅助化疗后腋窝淋巴结转移乳腺癌患者淋巴结转移高危因素分析

Analysis of risk factors for lymph node metastasis in breast cancer patients after axillary lymph node metastasis after neoadjuvant chemotherapy

目的分析新辅助化疗后腋窝淋巴结转移乳腺癌患者淋巴结转移高危因素。方法回顾性分析2017年1月至2019年12月广东省东莞市人民医院乳腺科收治的94例浸润性乳腺癌女性患者临床资料。所有患者均拟接受4~8个周期的新辅助化疗,化疗结束后行乳腺癌改良根治术,术后雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)及人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)阳性患者接受内分泌或靶向治疗,其余患者根据情况接受2~4个周期的辅助化疗或放疗。分析患者新辅助化疗后淋巴结转移情况以及临床病理特征与新辅助化疗后淋巴结转移的关系,采用Logistic回归分析患者新辅助化疗后淋巴结转移危险因素。结果腋窝淋巴结阳性乳腺癌患者新辅助化疗后腋窝淋巴结阳性率为74.47%(70/94);术前腋窝淋巴结阳性数目、ER状态、HER-2状态、细胞增殖抗原标记物(cell proliferation-associated human nuclear antigen,Ki67)表达、完成化疗周期情况、化疗后腋窝淋巴结病理缓解情况和新辅助化疗后肿瘤T分期与腋窝淋巴结阳性乳腺癌患者新辅助化疗后淋巴结转移有关(χ^(2)值分别为30.053、10.233、6.303、7.666、18.162、10.148、12.418,P均<0.05);术前腋窝淋巴结阳性数目>3(OR=2.788,95%CI1.253~5.318)、ER阳性(OR=3.298,95%CI1.744~7.837)、Ki67表达≤20%(OR=2.469,95%CI1.184~4.301)和新辅助化疗后腋窝淋巴结pPR(OR=4.197,95%CI2.168~13.788)为新辅助化疗后淋巴结转移的独立危险因素(P均<0.05)。结论腋窝淋巴结阳性乳腺癌患者新辅助化疗后腋窝淋巴结阳性率较高,术前腋窝淋巴结阳性数目>3枚、ER阳性、Ki67阳性和新辅助化疗后腋窝淋巴结pPR为新辅助化疗后淋巴结转移的独立危险因素。

s and texts positive patients received endocrine or targeted therapy.The rest patients received 2-4 cycles of adjuvant chemotherapy or radiotherapy according to the situation.Lymph node metastasis after neoadjuvant chemotherapy was analyzed.The relationship between lymph node metastasis after neoadjuvant chemotherapy and clinicopathological features was analyzed.Risk factors for lymph node metastasis after neoadjuvant chemotherapy were analyzed by Logistic regression.Results After neoadjuvant chemotherapy,the positive rate of axillary lymph node was 74.47%(70/94).The number of positive axillary lymph nodes,ER status,HER-2 status and cell proliferation-associated human nuclear antigen(Ki67),the completion of chemotherapy cycle,the pathological remission of axillary lymph nodes after chemotherapy and the T stage of tumor after neoadjuvant chemotherapy were associated with lymph node metastasis in patients with positive axillary lymph nodes after neoadjuvant chemotherapy(χ^(2)=30.053,10.233,6.303,7.666,18.162,10.148,12.418;all P<0.05).More than 3 positive axillary lymph nodes(OR=2.788,95%CI 1.253-5.318),ER positive(OR=3.298,95%CI 1.744-7.837),Ki67 positive(OR=2.469,95%CI 1.184-4.301)and pathological pPR(OR=4.197,95%CI 2.168-13.788)were independent risk factors for lymph node metastasis after neoadjuvant chemotherapy(all P<0.05).Conclusion Axillary lymph node-positive breast cancer patients have a high positive rate of axillary lymph nodes after neoadjuvant chemotherapy.More than 3 positive axillary lymph nodes before operation,ER positive,Ki67 positive,and axillary lymph node pPR after neoadjuvant chemotherapy are independent risk factors for lymph node metastasis after neoadjuvant chemotherapy.