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

doi:10.3877/cma.j.issn.1674-0793.2019.01.002

Abstract

Abstract:

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 (T_1-2N₀M₀) 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

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]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(01): 16-20.

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References 21

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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					-	0.609^a
	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					-	0.090^a
	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					-	0.677^a
	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)

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					-	0.609^a
	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					-	0.090^a
	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					-	0.677^a
	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)

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

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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