Risk assessment model for sentinel lymph node and non-sentinel lymph node metastases in patients with invasive breast cancer

doi:10.3877/cma.j.issn.1674-0807.2022.06.001

Abstract

Abstract:

Objective

To investigate the risk factors for sentinel lymph node and non-sentinel lymph node metastasis in patients with invasive breast cancer, establish a visual nomogram model and guide clinical axillary management.

Methods

A retrospective analysis was performed in 497 patients with pathologically confirmed invasive breast cancer in the Department of Thyroid and Breast Surgery, North Jiangsu People’s Hospital from 2017 to 2020. Sentinel lymph node biopsy is performed in all patients. Univariate and multivariate logistic regression analysis was used to screen risk factors for sentinel and non-sentinel lymph node metastasis. The nomogram model and receiver operating characteristic (ROC) curve were drawn by the R 4.1.0 software, and the area under the curve (AUC) was calculated, and the calibration curve was created by the Calibrate function in the rms package to test the predictive effect of the model.

Results

Among 497 patients, 221 (44.5%) had sentinel lymph node metastasis and they all underwent axillary lymph node dissection (ALND). Among them, 141 cases had non-sentinel lymph node metastasis confirmed by routine pathological examination after surgery. Univariate analysis showed that albumin-to-globulin ratio (Z=-2.000, P=0.046), peripheral blood neutrophil-to-lymphocyte ratio (NLR) (Z=-2.137, P=0.033), histological grade (Z=-5.168, P<0.001), intravascular cancer thrombus (χ²=114.010, P<0.001), HER-2 (χ²=3.989, P=0.046), Ki-67 (χ²=6.860, P=0.009), mass location (χ²=72.593, P<0.001) were related to sentinel lymph node metastasis. Multivariate analysis showed that histological grade (grade 3 vs grade 1: OR=3.167, 95%CI: 1.201-8.356, P=0.002), intravasculature cancer thrombus (OR=9.115, 95%CI: 5.487-15.142, P<0.001), and mass location (upper outer quadrant vs upper inner quadrant: OR=0.133, 95%CI: 0.063-0.618, P<0.001) were independent predictors of sentinel lymph node metastasis. The 221 patients receiving ALND were divided into non-sentinel node metastatic group and non-metastatic group. Univariate analysis showed that lump size (χ²=9.406, P=0.002), peripheral blood neutrophil count (Z=-2.248, P=0.025), histological grade (Z=-3.270, P=0.001) and intravascular cancer thrombus (χ²=12.959, P<0.001) were related to non-sentinel lymph node metastasis. Multivariate analysis showed that mass size (OR=2.600, 95%CI: 1.420-4.760, P=0.002), intravascular cancer thrombus (OR=2.968, 95%CI: 1.640-5.369, P<0.001) and peripheral blood neutrophil count (OR=1.336, 95%CI: 1.060-1.684, P=0.014) were independent predictors of non-sentinel lymph node metastasis. The AUC of ROC curve was 0.828 (95%CI: 0.793-0.865) for sentinel lymph node and 0.712 (95%CI: 0.642-0.782) for non-sentinel lymph node metastasis. The C-index of the calibration curve was 0.828 for sentinel lymph node and 0.712 for non-sentinel lymph node metastasis, indicating high consistence with the actual results.

Conclusion

The nomogram model can predict the probability of sentinel and non-sentinel lymph node metastasis, providing guidance for precision axillary treatment in clinic.

Key words: Breast neoplasms, Sentinel lymph nodes, Nomograms

Simin Yuan, Xueying Wang, Xiangying Xie, Deyuan Fu, Jiaxin Zhang. Risk assessment model for sentinel lymph node and non-sentinel lymph node metastases in patients with invasive breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(06): 327-335.

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Figures/Tables 11

References 39

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变量	变量名	赋值
组织学分级	X₁	1级＝1; 2级＝2; 3级＝3
脉管内癌栓	X₂	无癌栓＝1；有癌栓＝2
肿块大小	X₃	≤2 cm＝1；>2 cm＝2
ER	X₄	阴性＝1；阳性＝2
PR	X₅	阴性＝1；阳性＝2
HER-2	X₆	阴性＝1；阳性＝2
Ki-67	X₇	低表达＝1；高表达＝2
分子分型	X₈	luminal型＝1；HER-2阳性型＝2；三阴型＝3
肿块位置	X₉	外上象限＝1；外下象限＝2；内下象限＝3；内上象限＝4
前哨淋巴结转移	Y₁	未转移＝0；转移＝1
非前哨淋巴结转移	Y₂	未转移＝0；转移＝1

变量	变量名	赋值
组织学分级	X₁	1级＝1; 2级＝2; 3级＝3
脉管内癌栓	X₂	无癌栓＝1；有癌栓＝2
肿块大小	X₃	≤2 cm＝1；>2 cm＝2
ER	X₄	阴性＝1；阳性＝2
PR	X₅	阴性＝1；阳性＝2
HER-2	X₆	阴性＝1；阳性＝2
Ki-67	X₇	低表达＝1；高表达＝2
分子分型	X₈	luminal型＝1；HER-2阳性型＝2；三阴型＝3
肿块位置	X₉	外上象限＝1；外下象限＝2；内下象限＝3；内上象限＝4
前哨淋巴结转移	Y₁	未转移＝0；转移＝1
非前哨淋巴结转移	Y₂	未转移＝0；转移＝1

临床病理特征		前哨淋巴结未转移(n＝276)	前哨淋巴结转移(n＝221)	检验值	P值
年龄(岁，±s)		52.64±10.22	52.39±9.65	t＝0.280	0.779
白蛋白/球蛋白[M(P₂₅，P₇₅)]		1.72(1.56，1.97)	1.77(1.61，2.00)	Z＝－2.000	0.046
PLR[M(P₂₅，P₇₅)]		128.79(105.41，164.09)	123.20(95.40，156.43)	Z＝－1.600	0.110
NLR[M(P₂₅，P₇₅)]		2.37(1.77，3.07)	2.15(1.57，2.98)	Z＝－2.137	0.033
中性粒细胞计数[×10⁹/L, M(P₂₅，P₇₅)]		3.89(2.94，4.70)	3.72(2.83，4.58)	Z＝－1.215	0.225
淋巴细胞数目[×10⁹/L, M(P₂₅，P₇₅)]		1.62(1.32，2.03)	1.68(1.33，2.13)	Z＝－1.118	0.263
血小板数目(×10⁹/L, ±s)		216.42±59.37	211.53±62.01	t＝0.894	0.372
组织学分级[例(%)]
	1级	30(10.9)	6(2.7)	Z＝－5.168	<0.001
	2级	111(40.2)	59(26.7)
	3级	135(48.9)	156(70.6)
脉管内癌栓[例(%)]
	有	29(10.5)	121(54.8)	χ²＝114.010	<0.001
	无	247(89.5)	100(45.2)	χ²＝114.010	<0.001
肿块大小[例(%)]
	≤2 cm	177(64.1)	132(59.7)	χ²＝1.011	0.315
	>2 cm	99(35.9)	89(40.3)	χ²＝1.011	0.315
ER[例(%)]
	阴性	97(35.1)	89(40.3)	χ²＝1.377	0.241
	阳性	179(64.9)	132(59.7)	χ²＝1.377	0.241
PR[例(%)]
	阴性	135(48.9)	112(50.7)	χ²＝0.153	0.696
	阳性	141(51.1)	109(49.3)	χ²＝0.153	0.696
HER-2[例(%)]
	阴性	205(74.3)	146(66.1)	χ²＝3.989	0.046
	阳性	71(25.7)	75(33.9)	χ²＝3.989	0.046
Ki-67[例(%)]
	低表达	102(37.0)	57(25.8)	χ²＝6.860	0.009
	高表达	174(63.0)	164(74.2)	χ²＝6.860	0.009
分子分型[例(%)]
	luminal型	155(56.2)	102(46.2)	χ²＝5.600	0.061
	HER-2阳性型	70(25.4)	75(33.9)
	三阴型	51(18.4)	44(19.9)
肿块位置[例(%)]
	外上象限	77(27.9)	143(64.7)	χ²＝72.593	<0.001
	外下象限	51(18.4)	30(13.6)
	内下象限	91(33.0)	35(15.8)
	内上象限	57(20.7)	13(5.9)

临床病理特征		前哨淋巴结未转移(n＝276)	前哨淋巴结转移(n＝221)	检验值	P值
年龄(岁，±s)		52.64±10.22	52.39±9.65	t＝0.280	0.779
白蛋白/球蛋白[M(P₂₅，P₇₅)]		1.72(1.56，1.97)	1.77(1.61，2.00)	Z＝－2.000	0.046
PLR[M(P₂₅，P₇₅)]		128.79(105.41，164.09)	123.20(95.40，156.43)	Z＝－1.600	0.110
NLR[M(P₂₅，P₇₅)]		2.37(1.77，3.07)	2.15(1.57，2.98)	Z＝－2.137	0.033
中性粒细胞计数[×10⁹/L, M(P₂₅，P₇₅)]		3.89(2.94，4.70)	3.72(2.83，4.58)	Z＝－1.215	0.225
淋巴细胞数目[×10⁹/L, M(P₂₅，P₇₅)]		1.62(1.32，2.03)	1.68(1.33，2.13)	Z＝－1.118	0.263
血小板数目(×10⁹/L, ±s)		216.42±59.37	211.53±62.01	t＝0.894	0.372
组织学分级[例(%)]
	1级	30(10.9)	6(2.7)	Z＝－5.168	<0.001
	2级	111(40.2)	59(26.7)
	3级	135(48.9)	156(70.6)
脉管内癌栓[例(%)]
	有	29(10.5)	121(54.8)	χ²＝114.010	<0.001
	无	247(89.5)	100(45.2)	χ²＝114.010	<0.001
肿块大小[例(%)]
	≤2 cm	177(64.1)	132(59.7)	χ²＝1.011	0.315
	>2 cm	99(35.9)	89(40.3)	χ²＝1.011	0.315
ER[例(%)]
	阴性	97(35.1)	89(40.3)	χ²＝1.377	0.241
	阳性	179(64.9)	132(59.7)	χ²＝1.377	0.241
PR[例(%)]
	阴性	135(48.9)	112(50.7)	χ²＝0.153	0.696
	阳性	141(51.1)	109(49.3)	χ²＝0.153	0.696
HER-2[例(%)]
	阴性	205(74.3)	146(66.1)	χ²＝3.989	0.046
	阳性	71(25.7)	75(33.9)	χ²＝3.989	0.046
Ki-67[例(%)]
	低表达	102(37.0)	57(25.8)	χ²＝6.860	0.009
	高表达	174(63.0)	164(74.2)	χ²＝6.860	0.009
分子分型[例(%)]
	luminal型	155(56.2)	102(46.2)	χ²＝5.600	0.061
	HER-2阳性型	70(25.4)	75(33.9)
	三阴型	51(18.4)	44(19.9)
肿块位置[例(%)]
	外上象限	77(27.9)	143(64.7)	χ²＝72.593	<0.001
	外下象限	51(18.4)	30(13.6)
	内下象限	91(33.0)	35(15.8)
	内上象限	57(20.7)	13(5.9)

临床病理特征		β值	Wald Z值	P值	OR值	95%置信区间
脉管内癌栓		2.210	72.817	<0.001	9.115	5.487~15.142
组织学分级
	1级(参照)	－	－	－	－	－
	2级	0.433	0.716	0.387	1.542	0.556~4.204
	3级	1.153	5.425	0.002	3.167	1.201~8.356
肿块位置
	外上象限(参照)	－	－	－	－	－
	外下象限	－1.084	12.401	<0.001	0.338	0.185~0.618
	内下象限	－1.554	29.488	<0.001	0.211	0.121~0.370
	内上象限	－2.015	28.094	<0.001	0.133	0.063~0.281

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