乳腺癌患者新辅助化疗后腋窝淋巴结阴性相关因素及预后价值分析

Analysis on factors associated with axillary lymph node negativity and prognosis after neoadjuvant chemotherapy in breast cancer patients

目的分析乳腺癌患者新辅助化疗(NAC)后腋窝淋巴结阴性的相关因素及预后价值。方法收集2011年1月至2021年12月在嘉兴市妇幼保健院接受NAC并行乳腺癌根治性手术的179例乳腺癌患者的临床资料,根据NAC后腋窝淋巴结状态分为阴性组(74例)和阳性组(105例)。比较两组患者临床资料,采用多因素logistic回归分析患者NAC后腋窝淋巴结阴性的影响因素。绘制Kaplan-Meier生存曲线,探讨NAC后腋窝淋巴结状态与预后的关系。结果两组患者年龄、BMI、月经状态、初始肿块最大径、肿块位置、病理类型、孕激素受体状态、ki-67表达、人表皮生长因子受体2状态和化疗方案等比较,差异无统计学意义(均P>0.05);初始腋窝淋巴结阴性(P<0.001)、雌激素受体(ER)阴性(P=0.027)、NAC后乳房病理学完全缓解(pCR)(P<0.001)是NAC后腋窝淋巴结阴性的独立影响因素。阴性组较阳性组有更高的5年无复发生存率(84.2%和67.5%,P<0.01)和5年总生存率(93.7%和77.7%,P<0.01)。结论初始腋窝淋巴结阴性、ER阴性、NAC后乳房p CR的患者,其NAC后腋窝淋巴结阴性可能性高,提示可采用腋窝前哨淋巴结活检来评估腋窝状态。NAC后腋窝淋巴结状态可能成为预测乳腺癌患者预后的重要指标。

Objective This study aims to investigate the factors associated with axillary lymph node negativity in breast cancer patients following neoadjuvant chemotherapy(NAC),as well as the relationship between these factors and patient prognosis.Methods A retrospective analysis was conducted on the clinicopathological data of 179 patients who underwent NAC followed by curative breast cancer surgery at the Jiaxing Maternity and Child Health Care Hospital from January 2011 to December 2021.Based on the axillary lymph node status post-NAC,patients were divided into two groups:a negative group comprising 74 patients and a positive group consisting of 105 patients.The clinical and pathological characteristics between these two groups were compared and independent predictors of axillary lymph node negativity were identified using multivariable logistic regression analysis.Additionally,the relationship between axillary lymph node status post-NAC and patients'relapse-free survival and overall survival was explored through Kaplan-Meier survival curve analysis.Results In this study,no significant differences were observed between the two patient groups in age,body mass index,menstrual status,the maximum diameter of the initial tumor,tumor location,pathological type,progesterone receptor status,expression of Ki-67,human epidermal growth factor receptor 2 status,and chemotherapy regimen(all P>0.05).The initial axillary lymph node negativity status(P<0.001),estrogen receptor(ER)negativity(P=0.027),and pathologic complete response(pCR)in the breast post-NAC(P<0.001)were identified as independent predictors of axillary lymph node negativity after NAC.Furthermore,patients in the axillary lymph node-negative group exhibited significantly higher 5-year relapse-free survival rates(84.2%vs.67.5%,P<0.01)and 5-year overall survival rates(93.7%vs.77.7%,P<0.01)than those of the positive group.Conclusion Patients exhibiting initial axillary lymph node negativity,ER negativity,and pCR in the breast following NAC demonstrates a higher likelihood of post-NAC axillary lymph node negativity.This finding suggests that under these conditions,the utilization of sentinel lymph node biopsy for further evaluation of axillary status may be considered.Moreover,the axillary lymph node status post-NAC may serve as a significant prognostic indicator for patient outcomes.