前哨淋巴结阳性乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析

Analysis on the risk factors for non-sentinel lymph node metastasis at axilla in breast cancer patients with positive sentinel lymph node

目的:分析前哨淋巴结(SLN)阳性乳腺癌患者腋窝非前哨淋巴节(NSLN)转移的危险因素。方法:收集2015年1月~2020年12月弋矶山医院收治的223例SLN阳性乳腺癌患者的临床病理资料,回顾性分析SLN阳性患者腋窝NSLN转移的危险因素。结果:本研究中223例SLN阳性的乳腺癌患者均进一步接受腋窝淋巴结清扫。SLN平均取出(4.1±3.1)枚,其中平均(1.7±1.2)枚阳性。其中89例患者的腋窝NSLN可见转移,转移率为39.91%。脉管浸润、神经浸润、腋窝淋巴结超声状态、肿瘤大小、SLN阳性数目与SLN阳性患者NSLN转移有关(P<0.05)。多因素Logistic回归分析显示,脉管浸润、神经浸润、超声腋窝淋巴结可疑阳性、肿瘤>2 cm及SLN阳性个数(≥3枚)为SLN阳性患者NSLN转移的危险因素(P<0.05)。结论:在SLN阳性的情况下,脉管浸润、神经浸润、超声腋窝淋巴结可疑阳性、肿瘤>2 cm及SLN阳性个数≥3枚的患者更容易出现腋窝NSLN转移。当患者出现以上危险因素时,患者更容易从腋窝淋巴结清扫中获益,建议进一步行腋窝淋巴结清扫。

Objective:To analyze the risk factors for non-sentinel lymph node(NSLN)metastasis at axilla in breast cancer patients with positive sentinel lymph node(SLN).Methods:Clinicopathological data were obtained from 223 cases of breast cancer with positive SLN treated in our hospital between January 2015 and December 2020,and retrospectively analyzed for the risk factors for NSLN metastasis at axilla in the patients with positive SLN.Results:All patients underwent axillary lymph node dissection.Averagely,1.7±1.2 SLN were positive in 4.1±3.1 SLN removed.NSLN metastasis was seen in 89 patients,with a metastasis rate of 39.91%.Vascular and nerve infiltration,ultrasound manifestation of axillary lymph nodes,tumor size,and the number of positive SLN were related to NSLN metastasis in patients with positive SLN(P<0.05).Multivariate logistic regression analysis showed that vascular and nerve infiltration,axillary lymph nodes suspected to be positive by ultrasonography,tumor size>2 cm,and the number of positive SLN≥3 were risk factors for NSLN metastasis at axilla(P<0.05).Conclusion:In the case of presence of positive SLN,NSLN metastasis at axilla commonly occurs in breast cancer patients with vascular and nerve infiltration,axillary lymph nodes suspected to be positive by ultrasonography,tumor size>2 cm,and the number of positive SLN≥3.Patients with the above risk factors are more likely to benefit from axillary lymph node dissection,and additional axillary lymph node dissection is recommended.