前哨淋巴结阳性乳腺癌患者发生非前哨淋巴结转移的危险因素分析

doi:10.16150/j.1671-2870.2021.03.010

摘要/Abstract

摘要：

目的:分析前哨淋巴结（sentinel lymph node, SLN）阳性乳腺癌患者发生非前哨淋巴结（non-SLN, nSLN）转移的危险因素。方法:回顾性分析2017年7月至2020年7月我院普外科收治的SLN阳性并行腋窝淋巴结清扫（axillary lymph node dissection, ALND）的乳腺癌患者154例,按其是否发生nSLN转移分为nSLN转移组（nSLN+组,73例）和无nSLN转移组（nSLN-组,81例）,对2组病例的临床病理资料进行单因素和多因素Logistic回归分析,探讨该人群发生nSLN转移的危险因素。结果:SLN阳性乳腺癌患者的nSLN转移率为47.4%（73/154）。单因素分析显示,原发肿瘤T分期、脉管侵犯情况、SLN阳性数目、人类表皮生长因子受体2（human epidermal growth factor receptor 2,HER-2）表达、中性粒细胞/淋巴细胞比值（neutrophils-lymphocytes ratio,NLR）、血小板/淋巴细胞比值（platelet-lymphocyte ratio,PLR）与nSLN转移相关;进一步行多因素Logistic回归分析显示,原发肿瘤T分期高（P=0.040,OR=2.235）、NLR>2.82（P=0.021,OR=2.073）和SLN转移数目>2枚（P=0.008,OR=3.763）是患者发生nSLN转移的独立危险因素。结论:原发肿瘤T分期越高、NLR>2.82和SLN阳性数目>2枚是SLN阳性乳腺癌患者发生nSLN转移的独立危险因素,对这部分患者进行ALND更有价值。

关键词: 乳腺癌, 前哨淋巴结, 非前哨淋巴结, 腋窝淋巴结清扫

Abstract:

Objective: To analyze the risk factors for non-sentinel lymph node (nSLN) metastasis in patients with sentinel lymph node-positive breast cancer. Methods: A retrospective analysis was performed on 154 breast cancer patients admitted to our hospital with SLN positive and axillary lymph node dissection. According to weather nSLN metastasis occurred or not, patients were divided into 2 groups : nSLN metastasis negative (nSLN-group,81 cases)and nSLN metastasis positive(nSLN+group,73cases).Univariate and multivariate Logistic regression were used to analyze risk factors for nSLN metastasis. Results: The rate of non-sentinel lymph node metastasis in patients was 47.4% (73/154). Univariate analysis showed that primary tumor T staging, vascular invasion, number of SLN positive, human epidermal growth factor receptor-2, neutrophils/lymphocytes ratio (NLR), and platelets/lymphocytes ratio (PLR) were associated with non-sentinel lymph node metastasis. Further multivariate Logistic regression analysis showed that primary tumor T stage (P=0.040, OR=2.235), NLR (P=0.021, OR=2.073), and number of SLN metastasis (P=0.008, OR=3.763) were independent risk factors for nSLN metastasis. Conclusions: High T stage of primary tumor, NLR>2.82, and the number of SLN>2 are independent risk factors for nSLN metastasis in SLN-metastasis. For patients with risk factors above mentioned,application of axillary lymph node dissection are more important in them.

Key words: Breast cancer, Sentinel lymph node biopsy, Nonsentinel lymph node, Axillary lymph node dissection

中图分类号:

R737.9

侯筱飒, 杨振江. 前哨淋巴结阳性乳腺癌患者发生非前哨淋巴结转移的危险因素分析[J]. 诊断学理论与实践, 2021, 20(03): 284-289.

HOU Xiaosa, YANG Zhenjiang. Risk factors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(03): 284-289.

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抗体	名称	厂商	批号	国家
雌激素受体	雌激素受体抗体试剂	中杉金桥	20100904	中国
孕激素受体	孕激素受体抗体试剂	中杉金桥	20110307	中国
HER-2	c-erbB-2	中杉金桥	V01012-04	中国
Ki-67	Ki-67抗体试剂	通灵生物医药	20629190G	中国
荧光原位杂交试剂	人类HER-2基因扩增检测试剂盒	中杉金桥	Wx173031-1	中国

指标	临界值	AUC（95%CI）	灵敏度	特异度	约登指数
NLR	2.82	0.767	0.781	0.679	0.460
PLR	141.38	0.772	0.849	0.63	0.479

临床病理特征	nSLN-组（n=81）	nSLN+组（n=73）	χ²值	P值
年龄（岁）
≤50	20（24.7）	25（34.2）	1.70	0.193
>50	61（75.3）	48（65.8）
绝经状态
否	19（23.5）	25（34.2）	2.19	0.139
是	62（76.5）	48（65.8）
肿瘤直径分期
T₁	49（60.5）	12（16.4）	41.84	P<0.001
T₂	23（28.4）	21（28.8）
T₃	9（0.11）	40（54.8）
组织学分级
Ⅱ	24（29.6）	16（21.9）	1.19	0.276
Ⅲ	57（70.4）	57（78.1）
脉管侵犯
否	35（43.2）	11（15.1）	14.51	P<0.001
是	46（56.8）	62（84.9）
神经侵犯
否	68（84.0）	54（74.0）	2.32	0.128
是	13（16.0）	19（26.0）
雌激素受体
-	17（21.0）	25（34.2）	3.40	0.065
+	64（79.0）	48（65.8）
孕激素受体
-	40（49.4）	39（53.4）	0.25	0.616
+	41（50.6）	34（46.6）
HER-2
-	40（49.4）	19（26.0）	8.86	0.003
+	41（50.6）	54（74.0）
Ki-67
-	29（35.8）	16（21.9）	3.58	0.059
+	52（64.2）	57（78.1）
NLR
≤2.82	55（67.9）	15（20.5）	34.73	P<0.001
>2.82	26（32.1）	58（79.5）
PLR
≤141.38	51（63.0）	11（15.0）	36.62	P<0.001
>141.38	30（37.0）	62（85.0）
SLN阳性数目（枚）
≤2	63（77.8）	16（21.9）	47.96	P<0.001
>2	18（22.2）	57（78.1）

相关因素	B	SE	Wald值	P值	OR值	95%CI
肿瘤分期	0.804	0.391	4.236	0.040	2.235	1.039	4.807
脉管侵犯	0.397	0.611	0.386	0.534	0.684	0.207	2.265
HER-2表达状态	0.085	0.491	0.030	0.863	0.918	0.351	2.406
NLR	0.729	0.526	1.918	0.021	2.073	0.739	5.816
PLR	0.632	0.553	1.303	0.254	1.881	0.636	5.564
SLN阳性数目	1.325	0.500	7.033	0.008	3.763	1.413	10.021