初诊乳腺癌内乳淋巴结转移的危险因素及临床意义

Risk factors and clinical significance of internal mammary lymph node metastasis in newly diagnosed breast cancer

目的分析初诊乳腺癌患者发生内乳淋巴结(IMLN)转移的危险因素,为内乳区放疗提供临床参考。方法回顾性分析河北医科大学第四医院2014-01-01-2016-01-01就诊的乳腺癌患者临床资料。共纳入690例患者,均为女性,年龄22~80岁,中位年龄48岁。应用χ^(2)检验和多因素logistic回归模型筛选IMLN转移的危险因素,采用Kaplan-Meier法和log-rank检验分析预后。结果初诊乳腺癌IMLN转移率为7.25%(50/690),其中84.00%(42/50)的乳腺癌患者合并腋窝淋巴结(ALN)阳性。多因素分析显示,年龄≤35岁(OR=3.236,P=0.003)、原发象限位于中央区或内象限(OR=2.347,P=0.008)、临床肿瘤长径>5 cm(OR=4.748,P=0.004)、ALN阳性≥4枚(OR=2.177,P=0.005)以及三阴性乳腺癌(OR=3.338,P=0.044)患者更易合并IMLN转移。内乳未转移和转移患者3年无进展生存(PFS)率分别为87.34%和74.00%(χ^(2)=18.565,P<0.001),总生存(OS)率分别为95.16%和88.00%(χ^(2)=28.744,P<0.001),差异均有统计学意义。IMLN转移患者的PFS和OS均差于未转移患者(χ^(2)_(PFS)=15.885,PPFS<0.001;χ^(2)_(OS)=13.306,POS<0.001)。结论年龄≤35岁、原发象限位于中央区或内象限、临床肿瘤长径>5 cm、ALN阳性≥4枚或三阴性高危因素的患者发生IMLN转移风险高,建议内乳淋巴引流区放疗。乳腺癌IMLN转移率相对较低,但PFS和OS较差。

Objective To analyze the risk factors of internal mammary lymph node(IMLN)metastasis in newly diagnosed patients with breast cancer and provide clinical reference for local treatment of internal mammary region.Methods The clinical data of breast cancer patients in Fourth Hospital of Hebei Medical University from January 1,2014to January 1,2016were retrospectively analyzed.A total of 690patients,all female,aged 22-80years,with a median age of 48years,were included.χ^(2)test and multivariate logistic regression model were used to screen for risk factors for IMLN metastasis,and the prognosis was analyzed by Kaplan-Meier test and log-rank test.Results The rate of internal mammary lymph nodes metastasis in newly diagnosed breast cancer was 7.25%(50/690),and 84.00%(42/50)of breast cancer patients had axillary positive lymph nodes(ALN);multivariate analysis showed that patients with age≤35years(OR=3.236,P=0.003),primary tumor located in the central or inner quadrant(OR=2.347,P=0.008),clinical tumor length>5cm(OR=4.748,P=0.004),positive axillary lymph nodes≥4(OR=2.177,P=0.005),and triple negative subtype(OR=3.338,P=0.044)were more likely to be associated with IMLN metastasis.The rate of 3-year progression free survival(PFS)were 87.34%and 74.00%(χ^(2)=18.565,P<0.001)for patients with non IMLN metastasis and IMLN metastasis,respectively.The overall survival(OS)rates were 95.16%and 88.00%(χ^(2)=28.744,P<0.001),with statistically significant differences.Patients with IMLN metastasis had poorer PFS and OS than those without IMLN metastasis(χ^(2)_(PFS)=15.885,PPFS<0.001;χ^(2)_(OS)=13.306,POS<0.001).Conclusion Patients with age≤35years,primary tumor located in the central or inner quadrant,clinical tumor length>5cm,positive axillary lymph nodes≥4,and triple negative subtype have a high risk of IMLN metastasis,so radiotherapy of IMLN is recommended.The rate of IMLN metastasis is relatively low,but PFS and OS are poor.