前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移影响因素分析

 目的  研究分析前哨淋巴结(sentinel lymph node,SLN)阳性的乳腺癌患者中非前哨淋巴结(non-sentinel lymph node,NSLN)转移的影响因素。  方法  回顾性分析复旦大学附属妇产科医院2010年至2013年治疗的SLN宏转移的临床早期乳腺癌患者144例,分析NSLN转移的影响因素。  结果  144例SLN宏转移临床早期乳腺癌患者平均年龄为(49.8±10.8)岁,平均肿瘤大小为(2.8±1.1) cm。中位阳性SLN数目为1枚(1~5枚),中位SLN数目为3枚(1~10枚),中位腋窝淋巴结清扫数目为15枚(8~38枚)。病理类型均为浸润性导管癌。术后上肢淋巴水肿发生率为19.4%。单因素分析得出原发肿瘤大小、脉管侵犯、阳性SLN数目以及分子分型是NSLN转移的影响因素。多因素回归分析得出原发肿瘤>2 cm(P=0.043,OR=3.421)、脉管侵犯阳性(P<0.000 1,OR=16.332)、阳性SLN数目≥2枚(P=0.007,OR=4.191)是NSLN转移的独立危险因素,而分子分型尽管显示Luminal B型及HER2型NSLN转移风险较高的趋势,但差异未达到统计学意义(P=0.077)。  结论  对于SLN宏转移的临床早期乳腺癌,原发肿瘤>2 cm、脉管侵犯阳性、阳性SLN数目≥2枚是NSLN转移的独立危险因素。

Analysis of risk factors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node

Objective  To analyze the risk factors of non-sentinel lymph node (NSLN) metastasis in breast cancer patients with positive sentinel lymph node (SLN).  Methods  One hundred and forty-four cases of breast cancer in clinical early stage with SLN macrometastasis treated in our hospital between 2010 and 2013 were included. The risk factors of NSLN metastasis were analyzed.  Results  The mean age of the 144 cases was (49.8±10.8) years, and the mean tumor size was (2.8±1.1) cm. Median number of positive SLN was 1 (range 1-5), median number of SLN removed was 3 (range 1-10), median number of axillary lymph nodes removed were 15 (range 8-38). Pathological type was infiltrating ductal carcinoma in all cases. Occurrence rate of lymphoedma was 19.4%. Univariate analysis showed correlation between tumor size, lymphovascular invasion, positive SLN number,molecular subtype and NSLN metastasis. Multivariate analysis by logistic regression showed that tumor size >2 cm (P=0.043,OR=3.421), positive lymphovascular invasion (P<0.0001,OR=16.332), positive SLN≥2 (P=0.007,OR=4.191) were independent risk factors of NSLN metastasis, whereas luminal B subtype and HER2 subtype showed a tendency of higher risk of NSLN metastasis without statistical significance (P=0.077).  Conclusions  For early-stage breast cancer with macrometastasis SLN, tumor size>2 cm, positive lymphovascular invasion, positive SLN≥2 are independent risk factors of NSLN metastasis.