1个前哨淋巴结阳性乳腺癌患者的腋窝非前哨淋巴结转移情况及危险因素分析

Whether axillary metastasis and risk factors of a positive breast cancer patient with sentinel lymph node

目的研究1个前哨淋巴结阳性的乳腺癌患者腋窝非前哨淋巴结(NSLN)转移情况及危险因素,为该类患者豁免腋窝淋巴结清扫(ALND)提供指导。方法选取2013年1月至2020年12月在哈尔滨医科大学附属肿瘤医院行前哨淋巴结活检(SLNB)证实仅有1个前哨淋巴结阳性且行ALND的乳腺癌患者465例,根据其腋窝NSLN转移情况,分为NSLN转移组104例,NSLN未转移组361例。比较两组的一般资料,采用二元Logistic回归分析腋窝NSLN转移的独立影响因素。结果465例仅1个前哨淋巴结转移的乳腺癌患者中,104例(22.4%)发生腋窝NSLN转移。其中,多个亚组患者的腋窝NSLN转移率<10%,如肿瘤T1a+b期的NSLN转移率仅9.1%、肿瘤T1期且前哨淋巴结数量>5个的腋窝NSLN转移率仅7.0%等。单因素分析结果显示,NSLN转移组与NSLN未转移组前哨淋巴结数、肿瘤T分期差异有统计学意义(P<0.05)。前哨淋巴结2~5个、肿瘤分期为T2~T3期的患者更容易发生腋窝NSLN转移。多因素Logistic回归分析显示,肿瘤分期为T2~T3期、前哨淋巴结数≤5个是患者腋窝NSLN转移的独立危险因素。结论仅有1个前哨淋巴结转移的乳腺癌患者总体腋窝NSLN转移率为22.4%,肿瘤T分期和前哨淋巴结数为腋窝NSLN转移的影响因素,在对仅1个前哨淋巴结阳性的乳腺癌患者豁免ALND时应重点考虑。

Objective The purpose of this study is to investigate the axillary non-sentinel lymph node(NSLN)metastasis and risk factors in breast cancer patients with only 1 sentinel lymph node(SLN)positive,and to provide direction and guidance for such patients to be exempt from axillary lymph node dissection(ALND).Methods The clinicopathological parameters of 465 patients with breast cancer who had just 1 positive SLN and received ALND in the Affiliated Cancer Hospital of Harbin Medical University from January 2013 to December 2020 were retrospectively analyzed,and based on axillary NSLN metastasis or not,NSLN metastasis group(104 cases)and NSLN non-metastasis group(361 cases)were established.Univariate and multivariate analyses were performed byχ^(2) test and binary Logistic regression analysis.Results 465 breast cancer patients with only 1 SLN metastasis,only 104(22.4%)had axillary NSLN metastasis.Moreover,the metastatic rate of axillary NSLNs in multiple subgroups was less than 10%,for example,the axillary NSLNs metastatic rate in tumor stage T1a+b was only 9.1%,and the metastatic rate of axillary NSLNs in tumor stage T1 with SLN number>5 was only 7.0%.Univariate analysis showed that there were significant differences in the number of SLN and T stage between NSLN metastasis group and NSLN non-metastasis group(P<0.05).Patients with 2-5 SLNs and tumor stage T2-T3 are more likely to have axillary NSLN metastasis.Multivariate Logistic regression analysis showed that tumor stage T2-T3 and the number of SLNs≤5 were independent risk factors for axillary NSLN metastasis.Conclusions Among breast cancer patients with only 1 SLN metastasis in this study,the overall axillary NSLN metastasis rate was 22.4%.In addition,as independent influencing factors of axillary NSLN metastasis,tumor size and SLN number should be taken into account when considering the exemption of ALND in patients with only one sentinel positive breast cancer.