分子分型与前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的相关性分析

目的:分析前哨淋巴结(SLN)阳性乳腺癌患者分子分型与非前哨淋巴结转移（NSLN）的相关性。方法:回顾性分析前哨淋巴结阳性且行腋窝淋巴结清扫术的274例浸润性导管癌患者的临床病理资料，对可能影响NSLN状态的变量进行单因素及多因素Logistic回归分析。结果:274例前哨淋巴结阳性患者中，NSLN转移92例（33.6%）。单因素分析结果显示，肿瘤大小（P=0.013）、脉管浸润（P =0.031）、SLN转移灶大小（P=0.002）、SLN（+）/SLN比率（P<0.001）、分子分型（P<0.001）与NSLN转移相关。多因素分析结果显示，肿瘤大小（OR=1.452；95% CI:1.020-2.068；P=0.039）、SLN微转移（OR=0.140；95% CI:0.030-0.663；P=0.013）、SLN（+）/SLN比率（OR=3.533；95%CI:1.834-6.806；P <0.001）以及分子分型是NSLN转移的独立预测因素。以Luminal A作为参考，Luminal B（OR=3.994，95% CI:1.961-8.131；P<0.001）和HER2过表达型（OR=3.252；95% CI:1.057-10.004；P=0.040）发生NSLN转移的风险显著增加，而三阴性乳腺癌发生NSLN转移风险并未明显增加（OR=1.560；95%CI:0.658-3.698；P =0.313)。结论:乳腺癌分子分型是前哨淋巴结阳性乳腺癌NSLN转移的独立预测因素，Luminal B和HER2过表达型更易出现NSLN转移。

Correlation analysis between molecular subtype and non-sentinel lymph node metastasis in breast cancer patietns with positive sentinel lymph nodes

Objective: To analyze whether molecular subtype is associated with non-sentinel lymph nodes (NSLN) metastasis and explore the risk factors for NSLN metastasis in patients with a positive SLN. Methods: The clinicopathologic data of 274 breast cancer patients with sentinel lymph node metastasis who underwent axillary lymph node dissection were collected. Independent risks for non-sentinel lymph node metastasis were assessed by univariate and multivariate analyses. Results:NSLN metastasis was found in 92(33.6%) of 274 patients with a positive SLN. Based on the results of the univariate analysis, the variables that were significantly associated with the incidence of NSLN metastasis in a SLN positive patient included tumor size (P=0.013), the size of SLN metastasis (P =0.002), lymphovascular invasion (P =0.031), the ratio of positive SLN(P<0.001) and molecular subtype(P<0.001). Using multivariate analysis, tumor size(OR = 1.452； 95% CI: 1.020-2.068； P = 0.039), the size of SLN metastasis(OR = 0.140； 95% CI: 0.030-0.663；P = 0.013), the ratio of positive SLN（OR=3.533 95%CI: 1.834-6.806；P<0.001） and molecular subtype were identified as independent predictors for non-SLN metastasis. Patients with Luminal B (OR=3.994; 95% CI: 1.961-8.131; P<0.001) and HER2 overexpression subtypes (OR=3.252; 95% CI:1.057-10.004； P=0.040) had a higher risk of NSLN metastasis than patients with the Luminal A subtype. However, patients with triple negative subtype did not have a higher risk than patients with Luminal A subtype (OR=1.560; 95%CI:0.658-3.698；P=0.313). Conclusion: Except for other factors, molecular subtype is a independent predictor for NSLN metastasis in patients with a positive SLN. Luminal B and HER2 overexpression subtypes have a higher risk of NSLN metastasis than patients with the Luminal A subtype and triple negative breast cancer.