前哨淋巴结阳性乳腺癌病人发生非前哨淋巴结转移的危险因素分析  

Risk factors for non-sentinel lymph node metastasis in patients with positive sentinel lymph node

作　　者：黄珍 归奕飞 廖文勇 刘媛 黄燕萍 邬凤鸣 丘海 HUANG Zhen;GUI Yifei;LIAO Wenyong;LIU Yuan;HUANG Yanping;WU Fengming;QIU Hai(Department of Breast Surgery,Liuzhou Worker’s Hospital,Liuzhou,Guangxi Zhuang Autonomous Region 545005,China)

机构地区：[1]柳州市工人医院乳腺病区,广西壮族自治区柳州545005

出　　处：《安徽医药》2021年第1期100-103,共4页Anhui Medical and Pharmaceutical Journal

基　　金：广西壮族自治区卫生健康委员会自筹课题(Z20200134)。

摘　　要：目的探讨前哨淋巴结(SLN)阳性病人发生非前哨淋巴结(NSLN)转移的相关危险因素。方法回顾性分析2014年1月至2019年2月于柳州市工人医院行前哨淋巴结活检(SLNB)的552例乳腺癌病人的临床病理资料,采用单变量与多变量分析SLN阳性病人发生NSLN转移的相关危险因素。结果552例行SLNB的乳腺癌病人中SLN阳性病人占18.3%(101例),进一步行腋窝淋巴结清扫(ALND)术后病理资料显示共37.6%(38例)病人发生NSLN转移。单因素分析提示,SLN阳性数目(t=21.127,P<0.001)、癌灶长径(21.30±2.18)比(30.60±1.17)mm、组织学分级(t=8.868,P=0.012)、脉管侵犯情况(t=23.732,P<0.001)及激素受体(ER/PR)状态(t=4.098,P=0.036)均与NSLN转移明显相关(P<0.05)。多因素分析提示,SLN阳性数目(P<0.001,OR=3.230,95%CI:1.676~6.225)、癌灶长径(P=0.008,OR=4.400,95%CI:1.469~13.182)、组织学分级(P=0.007,OR=1.980,95%CI:1.202~3.263)、脉管侵犯(P=0.005,OR=3.380,95%CI:1.432~7.980),是NSLN转移存在的显著影响因素。结论SLNB阳性病人中,SLN阳性数≥3枚、肿块体积大、组织分级高、伴随脉管侵犯均与NSLN转移密切相关,ALND仍是此类病人标准治疗方式。Objective To investigate the risk factors for non-sentinel lymph node(NSLN)metastasis in patients with positive sentinel lymph node(SLN).Methods The clinicopathological factors of 552 patients with breast cancer who underwent sentinel lymph node biopsy(SLNB)in Liuzhou Worker’s Hospital from January 2014 to February 2019 were retrospectively analyzed.Univariate and multivariate analysis were used to analyze the related factors affecting the status of NSLN in patients with positive SLN.Results Among 552 patients who underwent SLNB,SLN-positive patients accounted for 18.3%(101 cases).The pathological data after further axillary lymph node dissection(ALND)showed that 37.6%(n=38)patients had NSLN metastasis.Univariate analysis indicated that the number of positive sentinel lymph node(t=21.127,P<0.001),the invasive tumor size(21.30±2.18)vs.(30.60±1.17)mm,histological grade(t=8.868,P=0.012),lymphovascular invasion(LVI)(t=23.732,P<0.001),and hormone receptor(ER/PR)status(t=4.098,P=0.036)were significantly correlated with NSLN metastasis.The number of positive SLN(P<0.001,OR:3.230,95%CI:1.676-6.225),the invasive tumor size(P=0.008;OR:4.400;95%CI:1.469-13.182),histological grade(P=0.007,OR:1.980,95%CI:1.202-3.263)and LVI(P=0.005,OR:3.380,95%CI:1.432-7.980)were significant influencing factorsfor NSLN metastasis as indicated bythe multivariate analysis.Conclusions In patients with positive SLN,the number of positiveSLN(≥3),large mass,high histological grade and LVI are closely related to NSLN metastasis.ALND is still the standard treatment for these patients.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 肿瘤微转移 脉管侵犯 组织学分级 非前哨淋巴结 危险因素 

分 类 号：R737.9[医药卫生—肿瘤]