乳腺癌哨兵淋巴结转移与肿瘤大小和癌基因及激素受体表达关系的临床观察

目的：探讨影响乳腺癌哨兵淋巴结转移的相关因素。方法：回顾性分析近2年来原发性乳腺癌115例临床资料。行哨兵淋巴结活检（SLNB）与腋窝淋巴结清扫术（ALND）;肿瘤直径≤2cm和2.1~4cm;免疫组化法检测肿瘤组织中C erbB 2，（HER 2/neu）p53，nm23，ER和PR的表达状态及对哨兵淋巴结（SN）转移的影响程度。结果：115例乳腺癌SN检出110例（检出率95.65％）,哨兵淋巴结与腋淋巴结病理结果完全符合，同时相关资料齐全可供分析的95例。其中SN转移36例（37.89％）,SN无转移59例（62.11％），平均每例检出淋巴结1.97枚。SN转移率在肿瘤直径≤2cm组和2.1~4cm组分别是21.43%（9/42）和50.94%(27/53)，两组相比较，随着原发肿瘤的增大SN阳性率相应提高并差异显著（P＜0.01）。SN转移率C erbB 2阴性组为24.32％（9/37），阳性组为46.55％（27/58），两组相比，随着C erbB 2表达增强，SN转移率显著提高并有统计学差异（P＜0.05）。p53, nm23, ER和 PR表达和不表达时影响SN的转移率，但无统计学意义（P＞0.05）。 结论：乳腺癌原发肿瘤大小，C erbB 2表达状态是预测SN转移状态的有用指标。

The relationship between sentinel node status and tumor size, oncogene, and estrogen and progesterone receptors status in breast cancer

Abstract:Objective：To investigate the correlative factors of sentinel lymph node(SN) metastasis status in breast cancer. Methods：The clinical data of 115 patients with breast cancer who underwent sentinel lymph node biopsy(SLNB) and axillary lymph node dissection(ALND) during June 2004 through April 2006 were retrospectively analysed. The SN metastasis were evaluated with regard to tumor size(≤2cm, 2.1cm~4cm)and C erbB 2、p53、nm23、ER、PR status. Results：Of the 115 patients SN was identified in 110(95.65％).An average of 1.97 SNs were examined per patient. Ninety five(86.37％)of 110 patients were correctiy diagnosed in SN and AN.Thirty six(37.89％)of 95 patients were SN positive, and 59(62.11％)were SN negative. Among the patients, SN metastasis rate in tumors 2.1cm~4cm(50.94％) in diameter was highter compared with those ≤2cm (23.43％) in size(P＜0.01). Among the patients with C erbB 2 expression, SN metastasis rate was 24.32％(9/37) in negative cases and 46.55％(27/58) in positive cases, which difference was significant(P＜0.05).However,the relation of negative or positive expression of p53, nm23 , EP and PR, to SN metastasis rate was not statistically different when compared(P＞0.05). Conclusions：Tumor size and C erbB 2 status were significantly associated with SN metastasis and may be used to predict SN metastasis in invasive breast cancer.