乳腺癌改良根治术中胸肌间淋巴结转移的临床特征及相关因素分析  

Analysis of clinical characteristics and influecing factors of interpectoral lymph nodes metastasis in modified radical mastectomy of breast cancer

作　　者：王强[1] 江川[1] 

机构地区：[1]福建医科大学附属闽东医院肿瘤科,福建宁德355000

出　　处：《中国医师进修杂志》2015年第1期44-47,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 分析乳腺癌患者胸肌间淋巴结的检出率、转移率及其影响因素,探讨胸肌间淋巴结清扫的意义和指征.方法 回顾性分析148例接受乳腺癌改良根治术并且胸肌间淋巴结单独送病理检查患者的临床资料,记录胸肌间淋巴结的检出率和转移情况,分析胸肌间淋巴结转移与肿瘤大小、腋窝淋巴结、临床分期、新辅助化疗、激素受体、人表皮生长因子受体2（Her-2）表达以及乳腺癌分子亚型的关系.结果 胸肌间淋巴结检出率、胸肌间淋巴结总体转移率、腋窝淋巴结阳性者胸肌间淋巴结转移率分别为13.5％（20/148）,4.7％（7/148）和10.9％（7/64）.不同腋窝淋巴结转移、肿瘤TNM分期患者胸肌间淋巴结转移率比较差异有统计学意义（P＜ 0.05）,但与激素受体状况、Her-2表达以及乳腺癌分子亚型之间未见相关（P＞0.05）;新辅助化疗并未降低肿瘤局部偏晚患者的胸肌间淋巴结转移率;胸肌间淋巴结转移者表现为肿瘤较大、腋窝淋巴结转移多、TNM分期较晚.结论 胸肌间淋巴结转移多见于肿瘤直径较大、腋窝淋巴结转移多、TNM分期较晚、局部晚期以及适合新辅助化疗的乳腺癌患者,这些指征可能意味着需要常规进行胸肌间淋巴结的手术清扫和单独送检.Objective To analyze the occurrence rate,positive rate,and other related factors influencing interpectoral lymph nodes in breast cancer patients,and to explore the significance and indications of the surgical dissection of interpectoral lympy nodes.Methods Clinical and pathological data from 148 breast cancer patients were retrospectively analyzed.All patients were subjected to modified radical mastectomy,and interpectoral lympy nodes were pathologically examined.The occurrence rate and metastasis of interpectoral lympy nodes were recorded,and the relationship between the interpectoral lympy nodes positive rate and tumor size,axillary nodes,clinical stages,neo-adjuvant chemotherapy,hormone receptors,human epidermal growth factor receptor-2 （Her-2） expression,and molecular subtypes of breast cancer were determined.Results The occurrence rate,overall metastasis rate,and the positive rate of interpectoral lympy nodes in patients with axillary lymph node metastasis were 13.5%（20/148）,4.7%（7/148）,and 10.9% （7/64）,respectively.I nterpectoral lympy nodes metastasis was significantly correlated with axillary node metastasis and clinical stages （P〈 0.05）.However,interpectoral lympy nodes metastasis was not significantly related with hormone receptor and Her-2 expressions（P 〉 0.05）.Interpectoral lympy nodes metastasis rate was not affected by neo-adjuvant chemotherapy.Patients with interpectoral lympy nodes metastasis were characterized by larger tumors,more positive axillary lymph nodes,and later chnical stages.Conclusions Interpectoral lympy nodes metastasis usually occurs in patients with larger tumors,more positive axillary lymph nodes,later clinical stages,as well as those with locally advanced cancer that meets the standard of neo-adjuvant chemotherapy.These indications suggest that the surgical dissection and pathological examination of interpectoral lymph nodes should be routinely performed.

关 键 词：乳腺肿瘤 乳房切除术 改良根治性 胸肌间淋巴结 影响因素 

分 类 号：R737.9[医药卫生—肿瘤]