早期乳腺癌患者非前哨淋巴结转移危险因素分析

Analysis of Risk Factors for Non-sentinel Lymph Node Metastasis in Early Breast Cancer Patients

目的:分析前哨淋巴结(SLN)阳性的乳腺癌患者非前哨淋巴结(NSLN)转移的危险因素。方法:收集并分析2013年1月至2020年1月在福建省立医院行手术治疗SLN阳性的临床早期乳腺癌患者,分析NSLN转移的相关影响因素。结果:443例SLN阳性乳腺癌患者NSLN转移167例。在单因素分析中,NSLN转移阳性者与NSLN转移阴性者在原发肿瘤大小、SLN阳性数目、SLN阴性数目、SLN转移数量、SLN转移阳性率以及SLN转移灶类型方面的差异均具有统计学意义(P <0.001)。多因素logistic回归分析结果显示,原发肿瘤大小T2、SLN阳性数量≥3枚、SLN转移阳性率≥50%以及SLN宏转移是NSLN转移的独立危险因素,独立危险因素联合预测NSLN转移的曲线下面积(AUC)为0.747> 0.7。结论:在SLN阳性的临床早期乳腺癌患者中,原发肿瘤大小T2、SLN阳性数量≥3枚、SLN转移阳性率≥50%以及SLN宏转移是患者发生NSLN转移的危险因素。上述各因素联合诊断能够较好的预测NSLN转移情况,指导外科手术,避免过度治疗。

Objective To analyze risk factors for non-sentinel lymph node(NSLN) metastasis in breast cancer patients with sentinel lymph node(SLN). Methods Clinical patients with early breast cancer who underwent surgery for positive SLN in Fujian Provincial Hospital from January 2013 to January 2020 were collected and analyzed, and the related influencing factors of NSLN metastasis were analyzed. Results There were 167 cases of NSLN metastasis in 443 positive SLN breast cancer patients.In a single factor analysis, there were statistically significant differences in primary tumor size, number of positive SLN, number of negative SLN, number of SLN metastasis, positive rate of SLN metastasis, and type of SLN metastasis between positive and negative patients with NSLN metastasis(P < 0.001). Multivariate logistic regression analysis showed that T2, positive number of SLN ≥ 3,positive rate of SLN metastasis ≥ 50 % and SLN macro metastasis were independent risk factors for NSLN metastasis, the area under curve(AUC) of independent risk factors combined predicted NSLN metastasis was 0.747 > 0.7. Conclusion In clinical early breast cancer patients with SLN positive, the primary tumor size T2, the number of SLN positive ≥ 3, the positive rate of SLN metastasis ≥ 50 % and SLN macro metastasis are the risk factors for the occurrence of NSLN metastasis. The combined diagnosis of the above factors can better predict the metastasis of NSLN, guide surgical procedures and avoid over-treatment.