不同分子分型1~2枚前哨淋巴结阳性乳腺癌免行腋窝淋巴结清扫的多因素分析

Multivariate analyses of breast cancer patients with 1–2 sentinel lymph nodes with different molecular types to avoid axillary lymph node dissection

目的:探讨不同分子分型1~2枚前哨淋巴结(sentinel lymph nodes,SLNs)阳性乳腺癌免行腋窝淋巴结清扫(axillary lymph node dissection,ALND)的临床病理因素,并为临床精准化提供依据。方法:回顾性分析2009年6月至2018年6月274例就诊于内蒙古医科大学附属医院和内蒙古医科大学附属人民医院经病理证实的乳腺癌患者的临床病理资料,采用单因素及Logistic多因素分析筛选1~2枚SLN阳性但非前哨淋巴结(nonsentinel lymph node,NSLN)转移率较低的患者,同时明确其与不同分子分型的关系。结果:274例1~2枚SLN阳性乳腺癌患者中,NSLN转移率为36.9%(101/274)。HER-2阳性(HR阳性)患者NSLN转移率最高,占55.3%(21/38);三阴性乳腺癌(triple negative breast cancer,TNBC)患者中NSLN转移率最低,占18.5%(5/27)。Luminal B型(HER-2阴性)乳腺癌患者的NSLN转移率明显高于Luminal A型(P=0.010)和TNBC患者(P=0.011);HER-2阳性(HR阳性)乳腺癌患者的NSLN转移率明显高于Luminal A型(P=0.002)和TNBC患者(P=0.003)。Logistic多因素分析显示,SLN转移数目(OR=4.022,95%CI为2.348~6.889,P<0.001),SLN检测(OR=3.846,95%CI为1.541~9.600,P=0.004),组织学分级(P<0.001)和分子分型(P=0.004)是1~2枚SLN阳性乳腺癌NSLN转移的独立影响因素。结论:Luminal B型(HER-2阴性)和HER-2阳性(HR阳性)患者的NSLN阳性率较高,SLN转移数目、SLN检测、组织学分级和分子分型是NSLN转移的独立影响因素。

Objective:To investigate clinicopathological factors of breast cancer patients having 1-2 sentinel lymph nodes(SLNs)with different molecular types for avoiding axillary lymph node dissection(ALND)and provide clinical evidence for preventing future ALND.Methods:This retrospective study included 274 patients with breast cancer that was confirmed via pathological examination in The Affiliated Hospital of Inner Mongolia Medical University and The Affiliated People’s Hospital of Inner Mongolia Medical University from June 2009 to June 2018.Univariate and Logistic multivariate analyses were used to screen patients with 1-2 SLNs with a low metastasis rate of non-SLN(NSLN)and to evaluate the relationships between NSLN and different molecular types.Results:The metastasis rate of NSLN was 36.9%(101/274)among 274 breast cancer patients with 1-2 SLNs.HER-2-positive(HR-positive)patients had the highest NSLN metastasis rate,accounting for 55.3%(21/38)of patients,while triple negative breast cancer(TNBC)patients had the lowest NSLN metastasis rate,accounting for 18.5%(5/27)of patients.The NSLN metastasis rate of patients with luminal B(HER-2-negative)breast cancer was significantly higher than that of patients with luminal A breast cancer(P=0.010)and TNBC(P=0.011).The NSLN metastasis rate of patients with HER-2-positive(HR-positive)breast cancer was significantly higher than that of patients with luminal A breast cancer(P=0.002)and TNBC(P=0.003).Logistic multivariate analyses revealed that the number of SLN metastases(OR=4.022,95%CI:2.348-6.889,P<0.001),SLN detection(OR=3.846,95%CI:1.541-9.600,P=0.004),histological grade(P<0.001),and molecular type(P=0.004)were independent influencing factors for NSLN metastasis in breast cancer patients with 1-2 SLNs.Conclusions:The NSLN metastasis rate was higher in patients with luminal B(HER-2-negative)and HER-2-positive(HR-positive)breast cancer.The number of SLN metastases,SLN detection,histological grade,and molecular typing were independent influencing factors for NSLN metastases.