前哨淋巴结阴性乳腺癌病人非前哨淋巴结转移相关危险因素分析

doi:10.16139/j.1007-9610.2024.05.08

摘要/Abstract

摘要：

目的：分析前哨淋巴结（SLN）阴性乳腺癌病人非前哨淋巴结（non-SLN, NSLN）转移的危险因素。方法：回顾性纳入2009年1月至2024年8月于我中心行全乳切除和前哨淋巴结活检的乳腺癌病人，在SLN阴性且行低位组淋巴结清扫的病人中，行NSLN转移相关危险因素单因素和多因素分析。结果：2 387例SLN阴性病人中，无NSLN转移者2 288例（95.9%），NSLN转移者99例（4.1%）。单因素及多因素分析显示：脉管侵犯(LVI)为SLN阴性病人NSLN转移的独立危险因素（13.5%比3.5%；OR=4.14，95%CI: 2.27~7.56，P<0.001）；与非多中心性乳腺癌相比，多中心性乳腺癌病人具有较高NSLN转移风险的趋势（9.5%比4.1%；OR=2.08，95% CI: 0.90~4.81，P=0.089）。结论：SLN阴性病人中，存在LVI、多中心性乳腺癌者具有较高NSLN转移风险。

关键词: 乳腺癌, 前哨淋巴结, 非前哨淋巴结转移, 脉管癌栓, 多中心性乳腺癌

Abstract:

Objective To analyze the risk factors for non-sentinel lymph node (NSLN) metastasis in patients with sentinel lymph node (SLN)-negative breast cancer. Methods Patients with breast cancer who underwent mastectomy and SLN biopsy at our center between January 2009 and August 2024 were retrospectively included. Univariate and multivariate analyses were performed in SLN-negative populations underwent low axillary lymph node dissection to identify risk factors for NSLN metastasis. Results A total of 2 387 SLN-negative patients were included, including 2 288 (95.9%) without NSLN metastasis and 99 (4.1%) with NSLN metastasis. Univariate and multivariate analyses showed that lymphovascular invasion (LVI) was an independent risk factor for NSLN metastasis in SLN-negative patients (13.5% versus 3.5%; OR=4.14，95% CI: 2.27-7.56，P<0.001). Patients with multicentric breast cancer showed a trend towards higher risk of NSLN metastasis compared to other types of breast cancer (9.5% versus 4.1%; OR=2.08，95% CI： 0.90-4.81，P=0.089). Conclusions Patients with SLN-negative biopsy who have LVI or multicentric breast cancer are at higher risk for NSLN metastasis.

Key words: Breast cancer, Sentinel lymph node(SLN), Non-sentinel lymph node(NSLN) metastasis, Lymphovascular invasion(LVI), Multicentric breast cancer

中图分类号:

R737.9

张丰哲, 童一苇, 陈小松, 沈坤炜. 前哨淋巴结阴性乳腺癌病人非前哨淋巴结转移相关危险因素分析[J]. 外科理论与实践, 2024, 29(05): 409-413.

ZHANG Fengzhe, TONG Yiwei, CHEN Xiaosong, SHEN Kunwei. Analysis of risk factors for non-sentinel lymph node metastasis in patients with sentinel lymph node-negative breast cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(05): 409-413.

图/表 3

图1

表1

SLN阴性病人NSLN转移相关危险因素单因素分析[n(%)]/M(范围)

Characteristic	NSLN（-）（n=2 288）	NSLN（+）（n=99）	P value
Median Age（Range）（year）	58（27-91）	57（30-85）	0.702
Age（year）
≤58	1 180（95.7）	53（4.3）
>58	1 108（96.0）	46（4.0）
Menopausal status			0.650
Premenopausal/ Perimenopause	736（95.6）	34（4.4）
Postmenopausal	1 552（96.0）	65（4.0）
BMI(kg/m²)			0.626
<25	1 668（96.0）	70（4.0）
≥25	619（95.5）	29（4.5）
NA	1（100.0）	0
Tumor location			0.025
Non-multicentric	1 752（95.9）	74（4.1）
Multicentric	76（90.5）	8（9.5）
NA	460（96.4）	17（3.6）
Tumor pathology			0.010
IDC	1 890（95.4）	91（4.6）
ILC	90（94.7）	5（5.3）
Others	308（99.0）	3（1.0）
Tumor grade			0.988
Ⅰ-Ⅱ	1 387（95.7）	63（4.3）
Ⅲ	751（95.7）	34（4.3）
NA	150（98.7）	2（1.3）
T stage			0.064
T1	1 406（96.4）	52（3.6）
T2	849（94.9）	46（5.1）
NA	33（97.1）	1（2.9）
ER status			0.045
Negative	675（97.1）	20（2.9）
Positive	1 610（95.3）	79（4.7）
NA	3（100.0）	0
PR status			0.096
Negative	906（96.7）	31（3.3）
Positive	1 378（95.3）	68（4.7）
NA	4（100.0）	0
HER2 status			0.088
Negative	1 575（96.3）	60（3.7）
Positive	594（94.7）	33（5.3）
NA	119（95.2）	6（4.8）
Ki-67(%)			0.266
<14	936（96.4）	35（3.6）
≥14	1 349（95.5）	64（4.5）
NA	3（100.0）	0
Molecular classification			0.167
Luminal	1 529（95.4）	73（4.6）
Basal-like	273（97.8）	6（2.2）
HER2-enriched	353（96.2）	14（3.8）
NA	133（95.7）	6（4.3）
LVI			<0.001
Negative	2 153（96.5）	78（3.5）
Positive	135（86.5）	21（13.5）
Number of dissected sentinel nodes			0.065
Median number（range）	3（1-6）	3（1-6）
1-2	595（94.6）	34（5.4）
≥3	1 693（96.3）	65（3.7）

表1

表2

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