前哨淋巴结宏转移的早期乳腺癌非前哨淋巴结转移危险因素分析

目的:探讨前哨淋巴结(SLN)宏转移的早期乳腺癌非前哨淋巴结(NSLN)转移的危险因素。方法:回顾性收集2014年1月—2016年12月诊治的196例SLN宏转移临床早期乳腺癌患者临床资料,分析各临床病理指标与NSLN转移的关系。结果:196例患者中,NSLN转移患者53例(25.5%)。单因素分析显示NSLN转移与年龄、月经状况、原发肿瘤位置、组织学分级、脉管瘤栓、Ki-67表达、HER-2表达、免疫组化分型无明显关系(均P>0.05),而与原发肿瘤大小、阳性SLN个数明显有关(均P<0.05)。多因素回归分析显示阳性SLN个数是NSLN转移的独立危险因素(P=0.000,OR=2.355)。结论:原发肿瘤大小、阳性SLN个数是SLN宏转移的临床早期乳腺癌患者NSLN转移重要因素,对于原发肿瘤>2cm,尤其阳性SLN数超过2枚的患者,建议行腋窝淋巴结清扫。

Analysis of risk factors for non-sentinel lymph node metastasis in early breast cancer with sentinel lymph node macrometastasis

Objective: To investigate the risk factors for non-sentinel lymph node (NSLN) metastasis in early breast cancer with sentinel lymph node (SLN) macrometastasis.  Methods: The data of 196 patients with clinical early-stage breast cancer and SLN macrometastasis treated from January 2014 to December 2016 were retrospectively collected. The associations of the clinicopathologic variables with NSLN metastasis were analyzed.Results: Of the 196 patients, NSLN metastasis occurred in 53 cases (25.5%). Univariate analysis showed that NSLN metastasis was not associated with age, menstrual status, primary tumor location, histological grade, vascular tumor thrombus, Ki-67 expression, HER-2 expression, and immunohistochemical type (all P>0.05), but was significantly related to primary tumor size and positive SLN number (both P<0.05). Multivariate regression analysis showed that the positive SLN number was an independent risk factor for NSLN metastasis (P=0.000, OR=2.355).  Conclusion: The primary tumor size and positive SLN number are important factors for NSLN metastasis in clinical early-stage breast cancer with SLN macrometastasis. For patients with primary tumor size greater than 2 cm, especially with more than two positive SLN, axillary lymph node dissection is recommended.