乳腺癌前哨淋巴结与非前哨淋巴结转移危险因素分析  

Risk factors of sentinel lymph node and non-sentinel lymph node metastasis in female breast cancer

作　　者：杨丽[1,2] 朱荔[1] 马金平 鲍宝石 刘丰源 刘紫朦 王建东 YANG Li;ZHU Li;MA Jin-ping;BAO Bao-shi;LIU Feng-yuan;LIU Zi-meng;WANG Jian-dong(Department of General Surgery,PLA General Hospital,Beijing 100853,P.R.China;Department of General Surgery,Beijing Shunyi Hospital,Beijing 101300,P.R.China;Department of General Surgery,Penglai People’s Hospital,Penglai 265600,P.R.China)

机构地区：[1]中国人民解放军总医院普通外科,北京100853 [2]北京市顺义区医院普通外科,北京101300 [3]蓬莱市人民医院普通外科,山东蓬莱265600

出　　处：《中华肿瘤防治杂志》2019年第22期1726-1731,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的前哨淋巴结活检(sentinel lymph node biopsy,SLNB)逐渐成为淋巴结阴性乳腺癌腋窝淋巴结处理的标准术式,并被临床广泛应用,本研究旨在了解乳腺癌患者SLNB现状,分析前哨淋巴结(sentinel lymph node,SLN)与非前哨淋巴结(non-sentinel lymph node,NSLN)转移风险预测因素。方法收集2009-09-01-2018-06-01解放军总医院普通外科收治的1 157例女性乳腺癌患者临床病理学资料,所有患者均由解放军总医院病理科检测并行SLNB,回顾性分析年龄、月经状况、肿瘤大小(T分期)、病理类型、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)、细胞增殖抗原Ki-67表达状态及脉管癌栓与SLN及NSLN转移关系。结果 1 157例乳腺癌患者中SLN转移189例(16.3%),SLN转移患者均行腋窝淋巴结清除(axillary lymph node dissection,ALND),术后常规病理检查证实NSLN转移71例(37.6%)。单因素分析显示,患者年龄(χ^2=4.634,P=0.031)、月经情况(χ^2=6.426,P=0.011)、肿瘤T分期(χ^2=54.912,P<0.001)、病理类型(χ^2=54.641,P<0.001)、Ki-67表达状态(χ^2=10.849,P=0.004)和有无脉管癌栓(χ^2=32.620,P<0.001)与SLN有无转移有关联。多因素分析显示,年龄≤50岁(OR=1.621,P=0.009)、病理类型为浸润型癌(OR=4.963,P=0.026)及伴有脉管癌栓(OR=2.997,P<0.001)是SLN是否有转移的危险因素。单因素分析显示,脉管癌栓(χ^2=12.859,P<0.001)和SLN阳性数/活检数比值(χ^2=4.406,P=0.032)与NSLN有无转移有关联。多因素分析显示,伴有脉管癌栓(OR=4.641,P=0.001)、SLN阳性数/活检数比值>0.5(OR=2.083,P=0.026)是NSLN是否有转移的危险因素。结论年龄≤50岁、伴有脉管癌栓、浸润性乳腺癌患者的SLN转移风险高,伴脉管癌栓与SLN阳性数/活检数比值>0.5的SLN阳性患者NSLN转移风险升高,对于SLN阳性患者可结合脉管癌栓及SLN阳性数/活检数比值预测NSLN的转移风险。OBJECTIVE Sentinel lymph node biopsy is widely used as the standard procedure for the treatment of axillary lymph nodes in axillary lymph node-negative breast cancer.This article aimed to study the status of SLNB in breast cancer patients and to analyze the risk predictors of the sentinel lymph node and non-sentinel lymph nodes metastases.METHODS Collected the clinical pathology data of 1 157 patients with breast cancer treated in the PLA general hospital from September 1 st 2009 to June 1 st 2018.Pathological specimens of all patients were examined by Pathology Department of PLA General Hospital and SLNB was performed.Retrospectively analyzed the relationship between the variables[patient age,menstrual status,tumor size(T stage),pathological type,expression status of ER,PR,HER-2 and Ki-67 and vascular tumor thrombus]and SLN and/or NSLN metastasis.RESULTS Totally 1 157 breast cancer patients,189(16.3%)patients had SLN metastasis who underwent further axillary lymph node dissection,71 cases(37.6%)had NSLN metastasis which were confirmed by postoperative pathology.Univariate analysis showed that patient age(χ^2=4.634,P=0.031),menstrual status(χ^2=6.426,P=0.011),tumor T stage(χ^2=54.912,P<0.001),pathological type(χ^2=54.641,P<0.001),Ki-67 expression status(χ^2=10.849,P=0.004)and the presence or absence of vascular tumor thrombus(χ^2=32.620,P<0.001)were associated with the presence or absence of SLN metastasis.Multivariate analysis showed that ages ≤50 years(OR=1.621,P=0.009),invasive breast cancer(OR=4.963,P=0.026)and presence of vascular tumor thrombus(OR=2.997,P<0.001)were risk factors for SLN metastasis.Univariate analysis showed that patients with vascular tumor thrombus(χ^2=12.859,P<0.001)and SLN positive number/biopsy number ratio(χ^2=4.406,P=0.032)were associated with NSLN metastasis.Multivariate analysis showed that presence of vascular tumor thrombus(OR=4.641,P=0.001)and the ratio of SLN positive number/biopsy number ratio>0.5(OR=2.083,P=0.026)was a risk factor for NSLN metastasis.CONCLUSIONS The

关 键 词：乳腺癌 前哨淋巴结 非前哨淋巴结 脉管癌栓 

分 类 号：R736.1[医药卫生—肿瘤]