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中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 91 -95. doi: 10.3877/cma.j.issn.1674-0807.2022.02.004

论著

1~2枚腋窝前哨淋巴结转移的乳腺癌患者非前哨淋巴结转移影响因素分析
乌帆1, 王耕2, 姚方辉2, 柴松山2, 李文仿2,()   
  1. 1. 121000 锦州医科大学研究生院;442000 十堰,湖北医药学院附属太和医院乳腺中心
    2. 442000 十堰,湖北医药学院附属太和医院乳腺中心
  • 收稿日期:2020-10-28 出版日期:2022-04-01
  • 通信作者: 李文仿

Influencing factors of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph nodes positive

Fan Wu1, Geng Wang2, Fanghui Yao2, Songshan Chai2, Wenfang Li2,()   

  1. 1. Graduate School of Jinzhou Medical University, Jinzhou 121000, China; Breast Disease Center, Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China
    2. Breast Disease Center, Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China
  • Received:2020-10-28 Published:2022-04-01
  • Corresponding author: Wenfang Li
引用本文:

乌帆, 王耕, 姚方辉, 柴松山, 李文仿. 1~2枚腋窝前哨淋巴结转移的乳腺癌患者非前哨淋巴结转移影响因素分析[J/OL]. 中华乳腺病杂志(电子版), 2022, 16(02): 91-95.

Fan Wu, Geng Wang, Fanghui Yao, Songshan Chai, Wenfang Li. Influencing factors of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph nodes positive[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(02): 91-95.

目的

探讨前哨淋巴结活组织检查(SLNB)后非前哨淋巴结(SLN)转移的影响因素。

方法

回顾性分析2015年3月至2020年9月湖北省十堰市太和医院收治的837例双染料示踪法SLNB有1~2枚转移且行腋窝淋巴结清扫的乳腺癌患者资料,分为非SLN有转移组(54例)和无转移组(783例),采用χ2检验比较2组患者的肿瘤直径、病灶位置、脉管侵犯、病理类型、多发病灶、SLN转移灶类型、分子分型、ER、PR、HER-2、Ki-67等临床病理特征,采用秩和检验比较2组患者的组织学分级和SLN转移率。采用Logistic回归分析影响乳腺癌患者腋窝非SLN转移的危险因素。

结果

2组患者的肿瘤直径、脉管侵犯、组织学分级、SLN转移率比较,差异均有统计学意义(χ2=3.940、45.882,Z=-2.225、-4.540,P=0.047、<0.001、0.027、<0.001)。多因素分析结果显示:有脉管侵犯、SLN转移率≥50%且<100%和SLN转移率为100%均为影响非SLN转移的独立危险因素( OR =4.826,95%CI: 2.675~8.706,P <0.001;OR=3.822,95%CI:1.538~9.501,P=0.004;OR=4.761,95%CI: 2.014~11.256,P<0.001)。

结论

有脉管侵犯或SLN转移率≥50%的乳腺癌患者,非SLN转移的风险增加,应行腋窝淋巴结清扫术。

Objective

To explore the factors affecting non-sentinel lymph node(non-SLN) metastasis after sentinel lymph node biopsy (SLNB).

Methods

We retrospectively analyzed the clinical data of 837 breast cancer patients who were SLNB positive via dual dye tracing and received axillary lymph node dissection in the Taihe Hospital Affiliated to Hubei Medical College from March 2015 to September 2020. Those patients were divided into non-SLN metastasis group (n=54) and non-metastasis group (n=783). The clinicopathological characteristics including tumor size, tumor location, vessel invasion, pathological type, mulifocality, SLN metastasis type, molecular subtype, ER, PR, HER-2 and Ki-67 were compared between two groups using χ2 test, and histological grading, SLN metastasis rate were compared between groups using the Rank sum test. Logistic regression equation was employed to analyze the factors affecting non-SLN metastasis.

Results

There were significant differences between two groups in tumor size, vessel invasion, histological grading and SLN metastasis rate (χ2=3.940, 45.882, Z=-2.225, -4.540; P=0.047, <0.001, 0.027, <0.001). The multivariate analysis indicated that vessel invasion, 50%≤SLN metastasis rate<100%, and SLN metastasis rate=100% were independent risk factors affecting non-SLN metastasis (OR=4.826, 95%CI: 2.675-8.706, P<0.001; OR=3.822, 95%CI: 1.538-9.501, P=0.004; OR=4.761, 95%CI: 2.014-11.256, P<0.001).

Conclusion

The patients with vessel invasion or SLN metastasis rate no less than 50% show increased risk of non-SLN metastasis, so axillary lymph node dissection should be performed.

表1 影响乳腺癌患者腋窝非前哨淋巴结转移的临床病理因素变量赋值表
表2 837例乳腺癌患者腋窝非前哨淋巴结转移影响因素的单因素分析[例(%)]
变量 腋窝非前哨淋巴结 检验值 P
无转移组(n=783) 有转移组(n=54)
病灶位置        
  外上 385(49.2) 21(38.9) χ2=3.372 0.498
  外下 83(10.6) 8(14.8)
  内上 133(17.0) 9(16.7)
  内下 63(8.0) 4(7.4)
  其他 119(15.2) 12(22.2)
肿瘤直径        
  <2 cm 313(40.0) 29(53.7) χ2=3.940 0.047
  ≥2 cm 470(60.0) 25(46.3)
病理类型        
  浸润性导管癌 770(98.3) 52(96.3) χ2=0.319 0.572
  其他类型癌 13(1.7) 2(3.7)
组织学分级        
  1级 133(17.0) 11(20.4) Z=-2.225 0.027
  2级 179(22.9) 20(37.0)
  3级 471(60.1) 23(42.6)
脉管侵犯        
  670(85.6) 27(50.0) χ2=45.882 <0.001
  113(14.4) 27(50.0)
多发病灶        
  699(89.3) 49(90.7) χ2=0.115 0.735
  84(10.7) 5(9.3)
SLN转移灶类型        
  微转移 191(24.4) 10(18.5) χ2=0.955 0.328
  宏转移 592(75.6) 44(81.5)
SLN转移率        
  <50% 341(43.5) 7(13.0) Z=-4.540 <0.001
  ≥50%且<100% 205(26.2) 18(33.3)
  100% 237(30.3) 29(53.7)
分子分型        
  三阴性乳腺癌 18(2.3) 0 χ2=6.815 0.078
  HER-2阳性型 385(49.2) 20(37.1)
  luminal A型 204(26.0) 22(40.7)
  luminal B型 176(22.5) 12(22.2)
ER        
  阴性 300(38.3) 16(29.6) χ2=1.621 0.203
  阳性 483(61.7) 38(70.4)
PR        
  阴性 369(47.1) 23(46.3) χ2=0.417 0.518
  阳性 414(52.9) 31(57.4)
HER-2        
  阴性 511(65.3) 37(68.5) χ2=0.237 0.626
  阳性 272(34.7) 17(31.5)
Ki-67        
  <14% 170(21.7) 12(22.2) χ2=0.008 0.930
  ≥14% 613(78.3) 42(77.8)
表3 837例乳腺癌患者腋窝非前哨淋巴结转移影响因素的多因素Logistic回归分析
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