1~2枚腋窝前哨淋巴结转移的乳腺癌患者非前哨淋巴结转移影响因素分析

Influencing factors of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph nodes positive

目的探讨前哨淋巴结活组织检查(SLNB)后非前哨淋巴结(SLN)转移的影响因素.方法回顾性分析2015年3月至2020年9月湖北省十堰市太和医院收治的837例双染料示踪法SLNB有1~2枚转移且行腋窝淋巴结清扫的乳腺癌患者资料,分为非SLN有转移组(54例)和无转移组(783例),采用X^(2)检验比较2组患者的肿瘤直径、病灶位置、脉管侵犯、病理类型、多发病灶、SLN转移灶类型、分子分型、ER、PR、HER-2、Ki-67等临床病理特征,采用秩和检验比较2组患者的组织学分级和SLN转移率.采用Logistic回归分析影响乳腺癌患者腋窝非SLN转移的危险因素.结果2组患者的肿瘤直径、脉管侵犯、组织学分级、SLN转移率比较,差异均有统计学意义(X^(2)=3.940、45.882,Z=-2.225、-4.540,P=0.047、<0.001、0.027、<0.001).多因素分析结果显示:有脉管侵犯、SLN转移率≥50%且<100%和SLN转移率为100%均为影响非SLN转移的独立危险因素(OR=4.826,95%CI:2.675~8.706,P<0.001;OR=3.822,95%CI:1.538~9.501,P=0.004;OR=4.761,95%CI:2.014~11.256,P<0.001).结论有脉管侵犯或SLN转移率≥50%的乳腺癌患者,非SLN转移的风险增加,应行腋窝淋巴结清扫术.

Objective To explore the factors affecting non-sentinel lymph node(non-SLN)metastasis after sentinel lymph node biopsy(SLNB).Methods We retrospectively analyzed the clinical data of 837 breast cancer patients who were SLNB positive via dual dye tracing and received axillary lymph node dissection in the Taihe Hospital Affiliated to Hubei Medical College from March 2015 to September 2020.Those patients were divided into non-SLN metastasis group(n=54)and non-metastasis group(n=783).The clinicopathological characteristics including tumor size,tumor location,vessel invasion,pathological type,mulifocality,SLN metastasis type,molecular subtype,ER,PR,HER-2 and Ki-67 were compared between two groups usingχ^(2)test,and histological grading,SLN metastasis rate were compared between groups using the Rank sum test.Logistic regression equation was employed to analyze the factors affecting non-SLN metastasis.Results There were significant differences between two groups in tumor size,vessel invasion,histological grading and SLN metastasis rate(χ^(2)=3.940,45.882,Z=-2.225,-4.540;P=0.047,<0.001,0.027,<0.001).The multivariate analysis indicated that vessel invasion,50%≤SLN metastasis rate<100%,and SLN metastasis rate=100%were independent risk factors affecting non-SLN metastasis(OR=4.826,95%CI:2.675-8.706,P<0.001;OR=3.822,95%CI:1.538-9.501,P=0.004;OR=4.761,95%CI:2.014-11.256,P<0.001).Conclusion The patients with vessel invasion or SLN metastasis rate no less than 50%show increased risk of non-SLN metastasis,so axillary lymph node dissection should be performed.