前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移影响因素分析  

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

作　　者：陈宏亮[1] 丁昂[1] 王富文[1] 王懋莉[1] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011

出　　处：《复旦学报（医学版）》2015年第4期460-466,共7页Fudan University Journal of Medical Sciences

摘　　要：目的研究分析前哨淋巴结（sentinel lymph node,SLN）阳性的乳腺癌患者中非前哨淋巴结（nonsentinel lymph node,NSLN）转移的影响因素。方法回顾性分析复旦大学附属妇产科医院2010年至2013年治疗的SLN宏转移的临床早期乳腺癌患者144例,分析NSLN转移的影响因素。结果 144例SLN宏转移临床早期乳腺癌患者平均年龄为（49.8±10.8）岁,平均肿瘤大小为（2.8±1.1）cm。中位阳性SLN数目为1枚（1~5枚）,中位SLN数目为3枚（1~10枚）,中位腋窝淋巴结清扫数目为15枚（8~38枚）。病理类型均为浸润性导管癌。术后上肢淋巴水肿发生率为19.4%。单因素分析得出原发肿瘤大小、脉管侵犯、阳性SLN数目以及分子分型是NSLN转移的影响因素。多因素回归分析得出原发肿瘤〉2 cm（P=0.043,OR=3.421）、脉管侵犯阳性（P〈0.000 1,OR=16.332）、阳性SLN数目≥2枚（P=0.007,OR=4.191）是NSLN转移的独立危险因素,而分子分型尽管显示Luminal B型及HER2型NSLN转移风险较高的趋势,但差异未达到统计学意义（P=0.077）。结论对于SLN宏转移的临床早期乳腺癌,原发肿瘤〉2 cm、脉管侵犯阳性、阳性SLN数目≥2枚是NSLN转移的独立危险因素。Objective To analyze the risk factors of non-sentinel lymph node（NSLN） metastasis in breast cancer patients with positive sentinel lymph node（SLN）. Methods One hundred and forty- four cases of breast cancer in clinical early stage with SLN macrometastasis treated in our hospital between 2010 and 2013 were included. The risk factors of NSLN metastasis were analyzed. Results The mean age of the 144 cases was （49.8± 10.8） years,and the mean tumor size was （2.8 ±1.1） cm. Median number of positive SLN was 1 （range 1-5） ,median number of SLN removed was 3 （range 1- 10）, median number of axillary lymph nodes removed were 15 （range 8-38）. Pathological type was infiltrating ductal carcinoma in all cases. Occurrence rate of lymphoedma was 19.4%. Univariateanalysis showed correlation between tumor size, lymphovascular invasion, positive SLN number,molecular subtype and NSLN metastasis. Multivariate analysis by logistic regression showed that tumor size 〉2 cm （P = 0. 043,OR = 3. 421）,positive lymphovascular invasion （P〈0.0001,OR = 16. 332）,positive SLN≥2 （P = 0. 007,OR = 4. 191） were independent risk factors of NSLN metastasis,whereas luminal B subtype and HER2 subtype showed a tendency of higher risk of NSLN metastasis without statistical significance （P = 0. 077）. Conclusions For early-stage breast cancer with macrometastasis SLN, tumor size〉2 cm, positive lymphovascular invasion,positive SLN≥2 are independent risk factors of NSLN metastasis.

关 键 词：乳腺癌 前哨淋巴结 非前哨淋巴结转移 危险因素 

分 类 号：R655.8[医药卫生—外科学]