摘要
目的探讨影像学检查内乳淋巴结(IMN)阴性的乳腺癌患者IMN转移的独立危险因素和术前IMN转移风险评估方法,以指导不同IMN转移风险分层患者的内乳淋巴引流区放疗。方法2012年1月至2019年10月山东省肿瘤医院手术治疗的301例乳腺癌患者,术前CT和MRI均显示无IMN转移且行内乳前哨淋巴结活检和(或)内乳淋巴结清扫,回顾性分析其临床病理资料。通过单因素分析和多因素logistic回归分析明确IMN转移的独立危险因素,利用IMN转移的独立危险因素对患者进行IMN转移风险分层。结果301例患者中,43例检出IMN转移,IMN转移率为14.3%。单因素分析显示,脉管瘤栓、孕激素受体(PR)表达状态、T分期和N分期与IMN转移有关(均P<0.05)。多因素logistic回归分析显示,肿瘤位于内侧象限、PR阳性、腋窝淋巴结转移是IMN转移的独立危险因素(均P<0.05)。按照患者存在独立危险因素的情况进行IMN转移风险评估:有0个危险因素为低危组,有1个危险因素为中危组,同时有2~3个危险因素为高危组。按照此评估标准,将301例乳腺癌患者分为低危组(有0个危险因素)、中危组(有1个危险因素)、高危组(有2~3个危险因素),IMN转移率分别为0(0/34)、4.3%(6/140)和29.1%(37/127)。结论根据肿瘤位于内侧象限、PR阳性、腋窝淋巴结转移这3项乳腺癌患者IMN转移的独立危险因素进行IMN转移的风险分层,可以指导乳腺癌初诊患者内乳淋巴引流区放疗。对于N1患者,伴原发肿瘤位于内侧象限和(或)PR阳性时,强烈建议进行内乳淋巴引流区放疗。
Objective To explore the independent risk factors of internal mammary lymph nodes(IMN)metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination,and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis.Methods The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB)and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively.The independent risk factors were analyzed by univariate and multivariate logistic regression,and the independent risk factors of IMN metastasis were used to risk stratification.Results Among the 301 patients,43 patients had IMN metastasis,and the rate of IMN metastasis was 14.3%.Univariate analysis showed that vascular tumor thrombus,progesterone receptor(PR)expression,T stage and N stage were associated with IMN metastasis.Multivariate logistic regression analysis showed that tumor located in medial quadrant,positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis.The risk of IMN metastasis was assessed according to the independent risk factors of the patients:low-risk group is including 0 risk factor,medium-risk group is including 1 risk factor,and high-risk group is including 2-3 risk factors.According to this evaluation criteria,301 patients with breast cancer were divided into low-risk group(with 0 risk factors),medium-risk group(with 1 risk factor)and high-risk group(with 2-3 risk factors).The IMN metastasis rates were 0(0/34),4.3%(6/140)and 29.1%(37/127),respectively.Conclusions The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant,positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients.
作者
杨成林
李建彬
王玮
王雪
张英杰
邵倩
王金之
Yang Chenglin;Li Jianbin;Wang Wei;Wang Xue;Zhang Yingjie;Shao Qian;Wang Jinzhi(Graduate College,Shandong First Medical University and Shandong Academy of Sciences,Jinan 250117,China;Department of Radiation Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;The First Ward of Chest Radiotherapy,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;Tianjin Normal University Hospital,Tianjin 300387,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2022年第5期410-415,共6页
Chinese Journal of Oncology
基金
山东省自然科学基金(ZR2020QH260)
泰山学者项目(ts20190982)
山东省医学会乳腺疾病科研基金(YXH2020ZX062)。
关键词
乳腺肿瘤
内乳淋巴结
淋巴结转移
内乳区放疗
Breast neoplasms
Internal mammary lymph nodes
Lymph node metastasis
Internal mammary node irradiation
