Analysis of risk factors for non-sentinel lymph node metastasis in patients with sentinel lymph node-negative breast cancer

doi:10.16139/j.1007-9610.2024.05.08

Abstract

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

CLC Number:

R737.9

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.

Figures/Tables 3

Fig 1

Tab 1

Univariate analysis of risk factors for NSLN metastasis in patients with SLN-negative breast cancer [n(%)]/M(range)

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）

Tab 1

Tab 2

References 16

[1]	BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	CHANG J M, LEUNG J W T, MOY L, et al. Axillary nodal evaluation in breast cancer: state of the art[J]. Radiology, 2020, 295(3):500-515. doi: 10.1148/radiol.2020192534 pmid: 32315268
[3]	VERONESI U, PAGANELLI G, VIALE G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6):546-553.
[4]	MANSEL R E, FALLOWFIELD L, KISSIN M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial[J]. J Natl Cancer Inst, 2006, 98(9):599-609.
[5]	HUNT K K, BALLMAN K V, MCCALL L M, et al. Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial[J]. Ann Surg, 2012, 256(3):428-436. pmid: 22868365
[6]	GALIMBERTI V, COLE B F, ZURRIDA S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial[J]. Lancet Oncol, 2013, 14(4):297-305.
[7]	HARLOW S P, KRAG D N, JULIAN T B, et al. Prerandomization Surgical Training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial: a randomized phase Ⅲ clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer[J]. Ann Surg, 2005, 241(1):48-54.
[8]	VERONESI U, PAGANELLI G, VIALE G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study[J]. Lancet Oncol, 2006, 7(12):983-990. doi: 10.1016/S1470-2045(06)70947-0 pmid: 17138219
[9]	CANAVESE G, CATTURICH A, VECCHIO C, et al. Sentinel node biopsy compared with complete axillary dissection for staging early breast cancer with clinically negative lymph nodes: results of randomized trial[J]. Ann Oncol, 2009, 20(6):1001-1007. doi: 10.1093/annonc/mdn746 pmid: 19174453
[10]	ZAVAGNO G, DE SALVO G L, SCALCO G, et al. A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the sentinella/GIVOM trial[J]. Ann Surg, 2008, 247(2):207-213.
[11]	BRIERLEY J D, GOSPODAROWICZ M K, WITTEKIND C. TNM classification of malignant tumours[M]. 8th ed. New Jersey: Wiley Blackwell, 2017.
[12]	ELSTON C W, ELLIS I O. Pathological prognostic factors in breast cancer. i. the value of histological grade in breast cancer: experience from a large study with long-term follow-up[J]. Histopathology, 1991, 19(5):403-410. doi: 10.1111/j.1365-2559.1991.tb00229.x pmid: 1757079
[13]	KRAG D N, ANDERSON S J, JULIAN T B, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase Ⅲ trial[J]. Lancet Oncol, 2007, 8(10):881-888.
[14]	GOYAL A, NEWCOMBE R G, CHHABRA A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer-results of the ALMANAC validation phase[J]. Breast Cancer Res Treat, 2006, 99(2):203-208.
[15]	LEE S A, LEE H M, LEE H W, et al. Risk factors for a false-negative result of sentinel node biopsy in patients with clinically node-negative breast cancer[J]. Cancer Res Treat, 2018, 50(3):625-633. doi: 10.4143/crt.2017.089 pmid: 28759990
[16]	CHOK K S, SUEN D T, LIM F M, et al. Factors affecting false-negative breast sentinel node biopsy in Chinese patients[J]. ANZ J Surg, 2007, 77(10):866-869. pmid: 17803550