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

doi:10.3877/cma.j.issn.1674-0807.2022.02.004

Abstract

Abstract:

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.

Key words: Breast neoplasms, Sentinel lymph node biopsy, Risk factors

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]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(02): 91-95.

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References 24

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临床病理因素	变量	分类赋值
肿瘤直径	X	<2 cm＝1，≥2 cm＝2
组织学分级	X	1级＝1，2级＝2，3级＝3
脉管侵犯	X	无＝1，有＝2
SLN转移率	X	<50%＝1，≥50%且<100%＝2，100%＝3
非SLN转移	Y	无转移＝0，有转移＝1

临床病理因素	变量	分类赋值
肿瘤直径	X	<2 cm＝1，≥2 cm＝2
组织学分级	X	1级＝1，2级＝2，3级＝3
脉管侵犯	X	无＝1，有＝2
SLN转移率	X	<50%＝1，≥50%且<100%＝2，100%＝3
非SLN转移	Y	无转移＝0，有转移＝1

变量		腋窝非前哨淋巴结		检验值	P值
变量		无转移组(n＝783)	有转移组(n＝54)	检验值	P值
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)	χ²＝3.940	0.047
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)	χ²＝0.319	0.572
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
	无	670(85.6)	27(50.0)	χ²＝45.882	<0.001
	有	113(14.4)	27(50.0)	χ²＝45.882	<0.001
多发病灶
	无	699(89.3)	49(90.7)	χ²＝0.115	0.735
	有	84(10.7)	5(9.3)	χ²＝0.115	0.735
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)	χ²＝0.955	0.328
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)	χ²＝1.621	0.203
PR
	阴性	369(47.1)	23(46.3)	χ²＝0.417	0.518
	阳性	414(52.9)	31(57.4)	χ²＝0.417	0.518
HER-2
	阴性	511(65.3)	37(68.5)	χ²＝0.237	0.626
	阳性	272(34.7)	17(31.5)	χ²＝0.237	0.626
Ki-67
	<14%	170(21.7)	12(22.2)	χ²＝0.008	0.930
	≥14%	613(78.3)	42(77.8)	χ²＝0.008	0.930

变量		腋窝非前哨淋巴结		检验值	P值
变量		无转移组(n＝783)	有转移组(n＝54)	检验值	P值
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)	χ²＝3.940	0.047
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)	χ²＝0.319	0.572
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
	无	670(85.6)	27(50.0)	χ²＝45.882	<0.001
	有	113(14.4)	27(50.0)	χ²＝45.882	<0.001
多发病灶
	无	699(89.3)	49(90.7)	χ²＝0.115	0.735
	有	84(10.7)	5(9.3)	χ²＝0.115	0.735
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)	χ²＝0.955	0.328
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)	χ²＝1.621	0.203
PR
	阴性	369(47.1)	23(46.3)	χ²＝0.417	0.518
	阳性	414(52.9)	31(57.4)	χ²＝0.417	0.518
HER-2
	阴性	511(65.3)	37(68.5)	χ²＝0.237	0.626
	阳性	272(34.7)	17(31.5)	χ²＝0.237	0.626
Ki-67
	<14%	170(21.7)	12(22.2)	χ²＝0.008	0.930
	≥14%	613(78.3)	42(77.8)	χ²＝0.008	0.930

因素	B值	标准误	Wald值	OR值	95%置信区间	P值
有脉管侵犯	1.574	0.301	27.338	4.826	2.675~8.706	<0.001
SLN转移率≥50%且<100%	1.341	0.465	8.329	3.822	1.538~9.501	0.004
SLN转移率为100%	1.560	0.439	12.634	4.761	2.014~11.256	<0.001

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