T1期乳腺浸润性导管癌脉管侵犯的相关危险因素分析

目的：探讨T1期乳腺浸润性导管癌（IDC）患者发生淋巴管血管侵犯（LVI）的相关危险因素。方法：回顾性分析2017年1月至2022年6月温州医科大学附属第一医院收治的T1期IDC患者的临床病理资料及术前MRI图像。根据LVI结果分为阴性组和阳性组。在T2加权图像上（T2WI）上根据乳房水肿评分（BES）将肿瘤相关乳房水肿分为4级。再将其简化，BES2为轻度水肿，BES3 和BES4 合并为中重度水肿。采用单因素分析及二元Logistic回归模型进行统计学分析以确定IDC的各项特征是否与LVI相关。结果：本研究共纳入307例患者，阴性组262例，阳性组45例。与低组织学分级、淋巴结转移阴性相比，高组织学分级（OR =2.59，95%CI =1.19～5.61，P =0.016）、淋巴结转移阳性（OR =4.74，95%CI =2.39～9.43，P ＜0.001）更容易出现LVI阳性。乳房轻度水肿（OR =3.80，95%CI =1.78～8.14，P =0.001）、中重度水肿（OR =5.54，95%CI =2.25～13.60，P ＜0.001）相对于无水肿，出现LVI阳性的概率增加，但组间差异无统计学意义（P ＞0.05）。结论：乳房水肿、淋巴结状态和组织学分级是T1期乳腺IDC患者发生LVI的独立危险因素。

Risk factors of lymphovascular invasion in T1 breast cancer

Objective: To investigate the risk factors for lymphovascular invasion (LVI) in patients with breast invasive ductal carcinoma (IDC) stage T1. Methods: The clinic-pathological data and preoperative magnetic resonance images of T1 IDC patients were retrospectively collected from January 2017 to June 2022 in the First Affiliated Hospital of Wenzhou Medical University. According to the LVI results, they were divided into two groups. Tumor-related breast edema was classified into 4 grades according to the Breast Edema Score (BES) on T2-weighted images (T2WI). To simplify it, BES2 was classified as slight edema, and BES3 and BES4 were combined as moderate to severe edema. Univariate analysis and binary logistic regression model were used for statistical analysis to determine whether the characteristics of IDC were associated with LVI. Results: A total of 307 patients were included in this study, of whom 262 were LVI negative and 45 were LVI positive. Compared with low histological grade and negative lymph node metastasis, high histological grade (OR=2.59, 95%CI=1.19-5.61, P=0.016) and positive lymph node metastasis (OR=4.74, 95%CI=2.39-9.43, P<0.001) was more likely to be LVI positive. Compared with no edema, slight edema (OR=3.80, 95%CI=1.78-8.14, P=0.001) and moderate to severe edema (OR=5.54, 95%CI=2.25-13.60, P<0.001) had an increased probability of LVI positive, but there was no significant difference between groups (P>0.05). Conclusion: Breast edema, lymph node status and histological grade are independent risk factors for LVI in T1 breast IDC patients.