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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 16 -20. doi: 10.3877/cma.j.issn.1674-0793.2019.01.002

所属专题： 文献；

论著

前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析
张展强1, 袁凯涛2, 张德元1, 李杰1, 吕伟明1, 林颖1,†()   
  1. 1. 510080　广州，中山大学附属第一医院甲状腺乳腺外科
    2. 510080　广州，中山大学附属第一医院胃肠外科
  • 收稿日期:2018-01-09 出版日期:2019-02-01
  • 通信作者: 林颖
  • 基金资助:
    中山大学5010项目(2016007)

Study on prediction of nonsentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes

Zhanqiang Zhang1, Kaitao Yuan2, Deyuan Zhang1, Jie Li1, Weiming Lyu1, Ying Lin1,†()   

  1. 1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2018-01-09 Published:2019-02-01
  • Corresponding author: Ying Lin
  • About author:
    Corresponding author: Lin Ying, Email:
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引用本文：

张展强, 袁凯涛, 张德元, 李杰, 吕伟明, 林颖. 前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析[J/OL]. 中华普通外科学文献(电子版), 2019, 13(01): 16-20.

Zhanqiang Zhang, Kaitao Yuan, Deyuan Zhang, Jie Li, Weiming Lyu, Ying Lin. Study on prediction of nonsentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(01): 16-20.

目的

探讨前哨淋巴结（SLN）阳性乳腺癌患者的临床病理特征与非前哨淋巴结（NSLN）转移的关系。

方法

回顾性分析2010年1月至2016年1月中山大学附属第一医院500例行前哨淋巴结活检（SLNB）的临床分期为T1-2N0M0期乳腺癌患者资料，其中病理检查确诊SLN阳性、随后行腋窝淋巴结清扫（ALND）的乳腺癌患者共89例，总结其临床、病理因素的特征及其对腋窝NSLN转移的影响因素进行单因素及多因素Logistic分析。

结果

SLN阳性率为17.8%（89/500），49.4%（44/89）出现NSLN转移。单因素分析显示，NSLN转移与原发肿瘤分期、脉管浸润、SLN阳性数、SLN阳性率相关（χ2=4.062、36.084、7.003、10.889，P=0.044、<0.001、0.030、0.004）。进一步多因素Logistic回归分析显示，脉管浸润、SLN阳性率是NSLN转移的独立预测因子（OR=46.142，95%CI：11.821~258.472，P<0.000 1；OR=10.482，95%CI：2.564~51.312，P=0.002）。

结论

SLN阳性的乳腺癌患者，其原发肿瘤分期、肿瘤是否多发、脉管浸润、SLN阳性数、SLN转移率与腋窝NSLN转移相关。其中，脉管浸润及SLN阳性率≥0.5是SLN阳性乳腺癌患者腋窝NSLN转移的独立预测因子。

关键词: 乳腺肿瘤, 前哨淋巴结活组织检查, 非前哨淋巴结
Objective

To identify the correlation between clinicopathological factors and nonsentinel lymph node (NSLN) metastasis in breast cancer patients with positive sentinel lymph node (SLN).

Methods

The medical records of five hundred breast cancer patients (T1-2N0M0) who underwent sentinel lymph node biopsy (SLNB) in the First Affiliated Hospital of Sun Yat-sen University between January 2010 and January 2016 were reviewed. Those found to have positive SLN and subsequently subjected to axillary lymph node dissection (ALND) were included. The correlation between clinicopathological factors and NSLN metastasis were examined by univariate and multivariate statistical analyses.

Results

Eighty-nine (17.8%) of 500 breast cancer patients exhibited SLN metastasis who underwent SLNB. Among them, up to 49.4% (44/89) NSLN metastasis were found in positive SLN patients. Univariate analyses revealed that NSLN metastasis was associated with primary tumor size, lymphatic invasion, the number of positive SLN, and the ratio of positive SLNs (χ2=4.062, 36.084, 7.003, 10.889, P=0.044, <0.001, 0.030, 0.004). Multivariate analysis showed that lymphatic invasion and the ratio of positive SLNs were independent factors of NSLN metastasis (OR=46.142, 95%CI: 11.821-258.472, P<0.000 1; OR=10.482, 95%CI: 2.564-51.312, P=0.002).

Conclusion

NSLN metastasis is associatied with primary tumor size, multiple tumors, lymphatic invasion, the number of positive SLN, in addition, lymphatic invasion and the ratio of positive SLNs are independent factors of NSLN metastasis.

Key words: Breast neoplasms, Sentinel lymph node biopsy, Nonsentinel lymph node
表1 SLN阳性乳腺癌患者的临床病理特征[例(%)]
项目 例数 NSLN阳性 NSLN阴性 统计值 P值
年龄(岁) 1.009 0.604
≤40 19 8(42.1) 11(57.9)
>40~60 54 29(53.7) 25(46.3)
>60 16 7(43.7) 9(56.3)
病理类型 - 0.609a
浸润性导管癌 77 39(50.7) 38(49.4)
浸润性小叶癌 3 2(66.7) 1(33.3)
其他 9 3(33.3) 6(66.7)
手术方式 0.203 0.652
全乳切除 69 35(50.6) 34(49.3)
保乳 20 9(45.0) 11(55.0)
组织学分级 - 0.090a
1 4 0(0) 4(100.0)
2 66 36(54.5) 30(45.5)
3 19 8(42.1) 11(57.9)
是否多发 3.626 0.057
否 77 35(45.5) 42(54.5)
是 12 9(75.0) 3(25.0)
脉管浸润 36.084 <0.001
无 56 14(25.0) 42(75.0)
有 33 30(90.9) 3(9.1)
原发肿瘤分期 4.062 0.044
T1 44 17(38.6) 27(61.4)
T2 45 27(60.0) 18(40.0)
ER 2.582 0.108
+ 73 39(53.4) 34(46.6)
- 16 5(31.2) 11(68.8)
PR 0.574 0.449
+ 72 37(51.4) 35(48.6)
- 17 7(41.2) 10(58.8)
HER-2 0.103 0.748
+ 17 9(52.9) 8(47.1)
- 72 35(48.6) 37(51.4)
Ki-67 1.999 0.157
≤14 22 8(36.4) 14(63.6)
>14 67 36(53.7) 31(46.3)
SLN直径 - 0.677a
ITC 0 0(0) 0(0)
宏转移 83 42(50.6) 41(49.4)
微转移 6 2(33.3) 4(66.7)
SLN阳性（枚） 7.003 0.030
1 52 20(38.5) 32(61.5)
2 13 7(53.8) 6(46.2)
>2 24 17(70.8) 7(29.2)
SLN阳性率 10.889 0.004
<0.5 50 17(34.0) 33(66.0)
0.5~<1 20 14(70.0) 6(30.0)
1 19 13(68.4) 6(31.6)
表2 影响乳腺癌患者腋窝NSLN转移的多因素Logistic回归分析结果
因素 OR值 95%CI Wald值 P值
原发肿瘤分期 0.372 0.104~1.249 2.515 0.113
脉管浸润 46.142 11.821~258.472 24.670 <0.001
SLN阳性数 1.139 0.366~3.396 0.053 0.817
SLN阳性率 10.482 2.564~51.312 9.711 0.002
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