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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2015, Vol. 09 ›› Issue (02) : 101 -105. doi: 10.3877/cma. j. issn.1674-0807.2015.02.006

论著

前哨淋巴结阳性乳腺癌患者的临床病理特征与非前哨淋巴结转移的关系
万舰1,†(), 王永南1, 韩晓蓉1, 刘祎婷2, 伍彩霞1   
  1. 1.511400 广州,广东省妇幼保健院乳腺病中心
    2.511400 广州,广东省妇幼保健院内科
  • 收稿日期:2015-01-02 出版日期:2015-04-01
  • 通信作者: 万舰
  • 基金资助:
    广东省医学科研基金资助项目(B2014023)

Correlation between clinicopathologic characteristics and non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node

Jian Wan1,†(), Yongnan Wang1, Xiaorong Han1, Yiting Liu2, Caixia Wu1   

  1. 1.Breast Disease Center, Guangdong Women and Children’s Hospital, Guangzhou 511400, China
    2.Department of Medicine, Guangdong Women and Children’s Hospital, Guangzhou 511400, China
  • Received:2015-01-02 Published:2015-04-01
  • Corresponding author: Jian Wan
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引用本文：

万舰, 王永南, 韩晓蓉, 刘祎婷, 伍彩霞. 前哨淋巴结阳性乳腺癌患者的临床病理特征与非前哨淋巴结转移的关系[J/OL]. 中华乳腺病杂志(电子版), 2015, 09(02): 101-105.

Jian Wan, Yongnan Wang, Xiaorong Han, Yiting Liu, Caixia Wu. Correlation between clinicopathologic characteristics and non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(02): 101-105.

目的

探讨腋窝前哨淋巴结(SLN)阳性乳腺癌患者的临床病理特征与非前哨淋巴结(nSLN)转移的关系。

方法

回顾性分析2007 年1 月至2013 年7 月广东省妇幼保健院乳腺病中心379 例临床分期为T1-2N0M0 期、行SLN 活组织检查之后完成腋窝淋巴结清扫的乳腺癌患者资料,其中,SLN 转移(SLN+)患者共125 例,包括70 例nSLN 转移者(nSLN+组)和55 例nSLN 未转移者(nSLN-组)。 应用χ2 检验及Logistic Regression 模型逐步回归法分析临床病理特征与nSLN 转移的关系。

结果

44%(55/125)SLN 阳性患者的腋窝淋巴结转移仅限于SLN。 单因素分析显示,nSLN 转移与原发肿瘤直径、淋巴结外转移、阳性SLN 数目、ER 和PR 状态有关(Z=-2.075,P=0.038;χ2=8.545,P=0.003;χ2 =4.344,P=0.037;χ2=4.216,P=0.040;χ2 =6.186,P=0.013)。 多因素分析显示,淋巴结外转移、阳性SLN 数目≥2 枚、PR(+)为nSLN 转移的独立影响因素(OR=4.114, 95%CI: 1.550 ～10.919, P=0.005;OR=2.454, 95% CI: 1.027 ～5.867, P=0.043; OR=0.370, 95% CI: 0.165 ～0.832, P = 0.016)。

结论

淋巴结外转移、阳性SLN 数目≥2 枚及PR(+)的SLN 阳性乳腺癌患者更容易发生nSLN 转移。

关键词: 乳腺肿瘤, 前哨淋巴结, 肿瘤转移

Objective

To explore the correlation between clinicopathologic characteristics and nonsentinel lymph node (nSLN) metastasis in breast cancer patients with positive SLN.

Methods

We retrospectively analyzed the clinical data of totally 379 patients with dinical stage T1-2 N0M0 breast cancer in Guangdong Women and Children’s Hospital from January 2007 to July 2013, who underwent axillary lymph node dissection (ALND) after SLN biopgy. Among them,there were 125 patients with positive lymph nodes (SLN+),including 70 patients with non-SLN metastasis (nSLN+ group) and 55 patients without non-SLN metastasis (nSLNgroup). χ2 test and Logistic stepwise regression were used to analyze the correlation between clinicopathologic characteristics and non-SLN metastasis.

Results

The metastatic axillary lymph nodes in the 44%(55/125) of SLN+ patients were all SLN. Univariate analysis showed that non-SLN metastasis was associatied with primary tumor size(Z=-2.075,P=0.038), extranodal metastasis(χ2 =8.545,P=0.003), number of positive SLNs(χ2=4.344,P= 0.037), ER (χ2=4.216,P=0.040) and PR (χ2=6.186,P=0.013) status. Multivariate analysis showed that extranodal metastasis (OR=4.114, 95%CI: 1.550-10.919, P=0.005), number of positive SLNs≥2 (OR=2.454, 95%CI: 1.027-5.867, P=0.043) and PR(+) (OR=0.370, 95%CI:0.165-0.832, P=0.016) were independent influencing factors of non-SLN metastasis.

Conclusion

Breast cancer patients with extranodal metastasis, number of positive SLNs≥2 or PR(+) are more prone to non-SLN metastasis.

Key words: Breast neoplasms, Sentinel lymph node, Tumor metastasis
表1 乳腺癌患者非前哨淋巴结转移预测因素的Logistic 回归变量赋值表
变量 变量分类及赋值
非前哨淋巴结 未转移=0,转移=1
肿瘤直径 0.5～1.0 cm=1,1.1～2.0 cm=2,2.1～5.0 cm=3
淋巴结外转移 无=0,有=1
阳性SLN数目 1枚=0,≥2枚=1
ER状态 ER(+)=0,ER(-)=1
PR状态 PR(+)=0,PR(-)=1
表2 nSLN+组与nSLN-组乳腺癌患者的临床病理特征比较(例)
组别 例数 月经状态 原发肿瘤直径(cm) 组织学类型 组织学分级 淋巴结外转移 SLN数量 阳性SLN数目
绝经前 绝经后 0.5～1.0 1.1～2.0 2.1～5.0 浸润性导管癌 其他 1级 2级 3级 有 无 1枚 ≥2枚 1枚 ≥2枚
nSLN+ 70 52 18 3 23 44 56 14 6 55 9 25 45 28 42 44 26
nSLN- 55 38 17 6 24 25 44 11 11 36 8 7 48 22 33 44 11
检验值 χ2=0.412 Z=-2.075 χ2=0.000 Z=-1.032 χ2=8.545 χ2=0.000 χ2=4.344
P值 0.521 0.038 1.000 0.302 0.003 1.000 0.037
组别 例数 SLN转移率 ER PR HER-2/neu Ki67 分子分型
100% ＜100% + - + - + - ≥14% ＜14% Luminal A Luminal B1 Luminal B2 三阴型 HER-2阳性型
nSLN+ 70 45 25 55 15 53 17 15 55 45 25 20 28 9 6 7
nSLN- 55 28 27 34 21 30 25 15 40 33 22 16 14 7 10 8
检验值 χ2=2.268 χ2=4.216 χ2=6.186 χ2=0.577 χ2=0.241 χ2=4.695
P值 0.132 0.040 0.013 0.448 0.623 0.320
表3 乳腺癌患者非前哨淋巴结转移预测因素的Logistic 回归分析
因素 回归系 标准误 Wald值 P值 OR值 OR值的95%置信区间
淋巴结外转移 1.414 0.498 8.066 0.005 4.114 1.550～10.919
阳性SLN数目 0.898 0.445 4.077 0.043 2.454 1.027～5.867
PR状态 -0.993 0.413 5.784 0.016 0.370 0.165～0.832
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