行全乳切除术且伴1~2枚前哨淋巴结宏转移乳腺癌患者发生非前哨淋巴结转移的危险因素

Risk factors for breast cancer patients undergoing total mastectomy complicated with 1 to 2 sentinel lymph node macro-metastasis suffering from non-sentinel lymph node metastasis

目的 探讨行全乳切除术且伴1~2枚前哨淋巴结(SLN)宏转移的乳腺癌患者发生非前哨淋巴结(NSLN)转移的危险因素。方法 收集158例行全乳切除术伴1~2枚SLN宏转移并进一步行腋窝淋巴结清扫术的乳腺癌患者的临床病理资料。采用多因素Logistic回归模型分析患者发生NSLN转移的危险因素,采用受试者工作特征曲线评估影响因素诊断患者发生NSLN转移的效能。结果 158例患者中,共59例(37.34%)患者发生NSLN转移。与NSLN阴性患者相比,NSLN阳性患者的肿瘤直径更大,宏转移SLN比值更高,阴性SLN数更少,脉管侵犯率更高(均P<0.05)。多因素Logistic回归模型分析结果显示,肿瘤直径较大、宏转移SLN比值较高及伴脉管侵犯是行全乳切除术伴1~2枚SLN宏转移的乳腺癌患者发生NSLN转移的危险因素(均P<0.05)。受试者工作特征曲线分析结果显示,肿瘤直径为22 mm、宏转移SLN比值为0.33时,其诊断全乳切除术伴1~2枚SLN宏转移的乳腺癌患者发生NSLN转移的曲线下面积分别为0.660和0.650(均P<0.05)。结论 全乳切除术伴1~2枚SLN宏转移的乳腺癌患者有较高的NSLN转移率,其中肿瘤直径较大、宏转移SLN比值较高、有脉管侵犯的患者发生NSLN转移的风险增加。

Objective To explore the risk factors for breast cancer patients with total mastectomy complicated with 1-2 sentinel lymph node(SLN) macro-metastasis suffering from non-sentinel lymph node(NSLN) metastasis.Methods The clinicalpathological data of 158 breast cancer patients undergoing total mastectomy complicated with 1-2 SLN macro-metastasis and further undergoing axillary lymph node dissection were collected.The multivariate Logistic regression model was employed to analyze the risk factors for the patients suffering from NSLN metastasis,and the receiver operating characteristic curve was used to evaluate the efficiency of influencing factors in diagnosing the patients suffering from NSLN metastasis.Results Among 158 patients,59(37.34%) patients suffering from NSLN metastasis in total.Compared with the patients with NSLN negative,the patients with NSLN positive exhibited a larger tumor diameter,a higher ratio of SLN with macro-metastasis,less number of negative SLN,and a higher vascular invasion rate(all P<0.05).The results of multivariate Logistic regression model analysis revealed that large tumor diameter,high ratio of SLN with macro-metastasis,and complication of vascular invasion were the risk factors for breast cancer patients with total mastectomy complicated with 1-2 SLN macro-metastasis suffering from NSLN metastasis(all P<0.05).The results of receiver operating characteristic curve analysis showed that when tumor diameter was 22 mm,the ratio of SLN with macro-metastasis was 0.33,the areas under the curve of the above in diagnosing breast cancer patients with total mastectomy complicated with 1-2 SLN macro metastasis suffering from NSLN metastasis were 0.660 and 0.650,respectively(all P<0.05).Conclusion Breast cancer patients with total mastectomy complicated with 1-2 SLN macro-metastasis have preferably high metastasis rate of NSLN,among which the risk of occurrence of NSLN metastasis increases when patients with large tumor diameter,high ratio of SLN with macro-metastasis,and vascular invasion.