摘要
目的分析早期浸润性乳腺癌患者前哨淋巴结(SLN)、SLN转移患者非前哨淋巴结(NSLN)转移的相关危险因素,为建立SLN、SLN转移患者NSLN转移的预测模型提供依据。方法回顾性分析2014年1月至2018年12月嘉兴市妇幼保健院收治的成功行前哨淋巴结活检(SLNB)的542例早期浸润性乳腺癌患者的临床病理资料,进行单因素及多因素logistic回归分析,筛选SLN转移的危险因素、SLN转移患者NSLN转移的危险因素。结果单因素分析结果显示:病理肿瘤大小、脉管癌栓(LVI)、雌激素受体(ER)状态、孕激素受体(PR)状态均是影响SLN转移的危险因素(均P<0.05);病理类型、LVI、SLN转移数均是影响SLN转移患者NSLN转移的危险因素(均P<0.05)。年龄、肿块位置、乳房手术方式、组织学分级、人表皮生长因子受体2(HER2)状态、细胞增殖指数(Ki-67)、分子分型均与SLN转移、SLN转移患者NSLN转移无关(均P>0.05)。多因素logistic回归分析结果显示:病理肿瘤大小(OR=2.12,95%CI:1.12~3.57,P<0.01)、LVI(OR=3.77,95%CI:1.94~7.31,P<0.01)是影响SLN转移的独立危险因素;非浸润性导管癌(Non-IDC)(OR=7.20,95%CI:1.48~34.94,P<0.05),SLN转移数≥3枚(OR=10.74,95%CI:1.80~64.07,P<0.01)是影响SLN转移患者NSLN转移的独立危险因素。结论病理肿瘤大小、LVI可以作为预测早期浸润性乳腺癌SLN转移的指标;病理类型、SLN转移数可以作为预测SLN转移患者NSLN转移的指标。肿瘤直径大、伴LVI的乳腺癌患者应更加谨慎选择单纯行SLNB;有SLN转移的Non-IDC患者或SLN转移数≥3枚建议常规行腋窝淋巴结清扫。
Objective To investigate the risk factors of sentinel lymph node(SLN)metastasis in patients with early invasive breast cancer and the risk factors of non-sentinel lymph node(NSLN)metastasis in patients with SLN metastasis.Methods The clinicopathological data of 542 patients with early invasive breast cancer who underwent successful sentinel lymph node biopsy(SLNB)in Jiaxing University Affiliated Women and Children Hospital from January 2014 to December 2018 were retrospectively analyzed.The risk factors of SLN metastasis and the risk factors of NSLN metastasis in patients with SLN metastasis were examined by univariate and multivariate Logistic regression analyses.Results Univariate analysis showed that pathological tumor size,lymphovascular invasion(LVI),estrogen receptor(ER)status and progesterone receptor(PR)status were significantly correlated with SLN metastasis(P<0.05),while pathological type,LVI and number of metastasized SLNs were significantly correlated with NSLN metastasis(P<0.05).However,age,tumor location,breast surgical procedure,histological grade,human epidermal growth factor receptor 2(HER2)status,cell proliferation index(Ki67)expression,and molecular typing were not correlated with SLN metastasis or NSLN metastasis in patients with SLN metastasis(P>0.05).Multivariate analysis showed that pathological tumor size(OR:2.12,95%CI:1.12-3.57,P<0.01)and LVI(OR:3.77,95%CI:1.94-7.31,P<0.01)were independent risk factors of SLN metastasis.Non-invasive ductal carcinoma(non-IDC)(OR:7.20,95%CI:1.48-34.94,P<0.05)and sentinel metastasis≥3(OR:10.74,95%CI:1.80-64.07,P<0.01)were independent risk factors for NSLN metastasis in patients with SLN metastasis.Conclusion Pathological tumor size and LVI can be used as indicators to predict SLN metastasis in early invasive breast cancer.Pathological types and the number of metastasized SLNs can be used as indicators to predict NSLN metastasis in patients with SLN metastasis.SLNB should be chosen more carefully for breast cancer patients with large tumor diameter and LVI.
作者
蔡李芬
朱晓萍
唐婕
朱娟英
CAI Lifen;ZHU Xiaoping;TANG Jie;ZHU Juanying(Department of Breast,Jiaxing University Affiliated Women and Children Hospital,Jiaxing 314000,China)
出处
《浙江医学》
CAS
2021年第6期582-588,共7页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2018PY070)。
关键词
乳腺癌
前哨淋巴结
非前哨淋巴结
转移
危险因素
Breast cancer
Sentinel lymph node positive
Non-sentinel lymph nodes
Metastasis
Risk factors
