乳腺癌前哨淋巴结中Oct-4、VEGF-D、L-selectin水平与前哨淋巴结转移的关系及意义

Relationship Between the Levels of Oct-4,VEGF-D,L-selectin and Sentinel Lymph Node Metastasis in Breast Cancer and Its Significance

目的探讨乳腺癌前哨淋巴结中八聚体结合转录因子-4(Oct-4)、血管内皮生长因子-D(VEGF-D)、L-选择素(L-selectin)水平与前哨淋巴结转移(SLNM)的关系及意义。方法选取2020年4月—2022年7月收治的147例乳腺癌,根据SLNM情况分为SLNM组67例、无SLNM组80例,比较2组及不同T分期、区域淋巴结分期患者前哨淋巴结中Oct-4、VEGF-D、L-selectin水平,采用多因素Logistic回归分析寻找乳腺癌SLNM的危险因素,采用决策曲线分析(DCA)和临床影响曲线(CIC)分析前哨淋巴结中Oct-4、VEGF-D、L-selectin评估SLNM的临床效用和与实际情况的符合度。结果SLNM组前哨淋巴结中Oct-4、VEGF-D、L-selectin水平高于无SLNM组(P<0.01)。随着T分期和区域淋巴结分期升高,前哨淋巴结中Oct-4、VEGF-D、L-selectin水平逐渐升高,差异有统计学意义(P<0.05)。前哨淋巴结中Oct-4、VEGF-D、L-selectin均是乳腺癌患者SLNM的独立危险因素(P<0.01);绘制DCA曲线显示,前哨淋巴结中Oct-4、VEGF-D、L-selectin评估乳腺癌患者SLNM均有正向的净获益,临床效用排序:Oct-4、L-selectin、VEGF-D,三者联合较单独指标评估的临床获益度均明显升高;绘制CIC显示,阈概率值>0.6时,三者联合评估SLNM与实际情况具有较高的符合率。结论乳腺癌前哨淋巴结中Oct-4、VEGF-D、L-selectin水平与SLNM及肿瘤分期有关,是患者发生SLNM的一个潜在机制,三者联合评估SLNM具有良好的临床获益度,可作为评估乳腺癌患者SLNM的可靠方法。

Objective To investigate the relationship between octamer-binding transcription factor 4(Oct-4),vascular endothelial growth factor D(VEGF-D),L-selectin levels and sentinel lymph node metastasis(SLNM)in breast cancer and its significance.Methods A total of 147 patients with breast cancer admitted from April 2020 to July 2022 were selected and divided into SLNM group(n=67)and non-SLNM group(n=80).The levels of Oct-4,VEGF-D and L-selectin in sentinel lymph nodes of the two groups and patients with different T stages and regional lymph node stages were compared.Multivariate Logistic regression was used to analyze the risk factors of SLNM in breast cancer.Oct-4,VEGF-D and L-selectin in sentinel lymph nodes were analyzed by decision curve analysis(DCA)and clinical influence curve(CIC)to evaluate the clinical efficacy and the compatibility between SLNM and the actual situation.Results The levels of Oct-4,VEGF-D and L-selectin in sentinel lymph nodes in SLNM group were higher than those in non-SLNM group(P<0.01).With the increase of T stage and regional lymph node stage,the levels of Oct-4,VEGF-D and L-selectin in sentinel lymph nodes increased gradually,and the difference was statistically significant(P<0.05).Oct-4,VEGF-D and L-selectin were all independent risk factors for SLNM in breast cancer patients(P<0.05).DCA curve showed that Oct-4,VEGF-D,and L-selectin showed positive net benefit in the evaluation of SLNM in breast cancer patients.The clinical efficacy was ranked as follows:Oct-4,L-selectin,and VEGF-D,and the clinical benefit of the combination of the three indicators in evaluation was significantly higher than that of the single indicator.CIC curve was drawn to show that when the threshold probability value was>0.6,the SLNM evaluated by the three indicators had a high coincidence rate with the actual situation.Conclusion The levels of Oct-4,VEGF-D and L-selectin in sentinel lymph nodes of breast cancer are related to SLNM and tumor stage,which is a potential mechanism of SLNM in patients.The combined evaluation of the three has a good clinical benefit,and can be used as a reliable method to evaluate SLNM in breast cancer patients.