前哨淋巴结阳性乳腺癌新辅助化疗后非前哨淋巴结状态的影响因素  

Risk factors for non-sentinel lymph node metastasis in patients after neoadjuvant chemotherapy

作　　者：杨飏[1] 何英剑[1] 李金峰[1] 解云涛[1] 王天峰[1] 范照青[1] 范铁[1] 欧阳涛[1] 

机构地区：[1]北京大学临床肿瘤学院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室乳腺癌预防治疗中心,100142

出　　处：《中华医学杂志》2014年第34期2661-2664,共4页National Medical Journal of China

摘　　要：目的 探讨前哨淋巴结（SLN）阳性乳腺癌新辅助化疗后非前哨淋巴结（NSLN）状态的影响因素并建立非前哨淋巴结状态的预测模型.方法 选取北京肿瘤医院乳腺癌预防治疗中心数据库2005年8月至2013年3月SLN阳性并接受新辅助化疗的乳腺癌病例512例,探讨NSLN状态的影响因素,建立预测模型并评价预测价值.结果 腋窝淋巴结清扫后共115例（22.4％）病例NSLN存在转移.单因素分析中,患者肿瘤大小、SLN阳性数、激素受体（HR）、微转移、化疗临床评效是NSLN状态的影响因素,差异有统计学意义（P＜0.05）.多因素分析中,肿瘤大小、HR、SLN阳性数、微转移和化疗临床评效是NSLN状态的独立预测因子.ROC曲线下面积为0.779（95％ CI：0.732 ～0.825）.结论 患者年龄、肿瘤大小、SLN阳性数、微转移和化疗临床评效是化疗后病例NSLN状态的独立预测因子.据此建立的模型的预测价值有待进一步验证.Objective To evaluate the risk factors for non-sentinel lymph node（NSLN） metastasis in patients after neoadjuvant chemotherapy （NCT）so as to develop a new predictive model.Methods A total of 512 consecutive patients with metastasis in sentinel lymph node（SLN） on neoadjuvant chemotherapy between August 2005 and March 2013 were recruited to evaluate the factors affecting the involvement of NSLN.Logistic regression analysis was performed to construct a predictive model.Results There were 115 （22.4％） patients with metastasis in NSLN after axillary lymph node dissection.Univariate analysis showed that tumor size,number of positive SLN,hormone receptor（HR）,micrometastasis and clinical response of primary tumor after NCT were associated with the involvement of NSLN （P ＜ 0.05）.Multivariate analysis indicated that tumor size,number of positive SLN,HR,micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis.Area under the curve was 0.779.Conclusion Tumor size,number of positive SLN,HR,micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis in patients after NCT.The new model is to be further validated.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 预测模型 

分 类 号：R737.9[医药卫生—肿瘤]