前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析  

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

作　　者：张展强[1] 袁凯涛[2] 张德元[1] 李杰[1] 吕伟明[1] 林颖[1] Zhang Zhanqiang;Yuan Kaitao;Zhang Deyuan;Li Jie;Lyu Weiming;Lin Ying(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院甲状腺乳腺外科,广州510080 [2]中山大学附属第一医院胃肠外科,广州510080

出　　处：《中华普通外科学文献（电子版）》2019年第1期16-20,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：中山大学5010项目(2016007)

摘　　要：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T_(1-2)N_0M_0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(χ~2=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。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 Eightynine(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(χ^2=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.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 非前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]