前哨淋巴结阳性早期乳腺癌脉管浸润与非前哨淋巴结转移相关性研究  

Study on the relationship between lymphovascular invasion and non-sentinel lymph node metastasis in early-stage breast cancer with positive sentinel lymph node

作　　者：陈佳梅 罗茜茜 蔡高科 李文鹤[2] 刘立红 罗波[2] Chen Jiamei;Luo Xixi;Cai Gaoke;Li Wenhe;Liu Lihong;Luo Bo(Center of Oncology,Renmin Hospital of Wuhan University,the First Clinical College of Wuhan University,Wuhan 430060,China;Department of Pathology,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]武汉大学第一临床学院武汉大学人民医院肿瘤中心,武汉430060 [2]华中科技大学同济医学院附属武汉市中心医院病理科,武汉430014

出　　处：《肿瘤研究与临床》2021年第12期896-900,共5页Cancer Research and Clinic

基　　金：国家自然科学基金(81901820/H18);湖北省卫生健康科研基金(WJ2019H365);武汉市卫生健康科研基金(WX19Q18)。

摘　　要：目的探讨前哨淋巴结(SLN)阳性早期浸润性乳腺癌的脉管浸润与非前哨淋巴结(NSLN)转移的相关性及意义。方法回顾性分析2015年1月至2021年2月武汉市中心医院活组织检查显示SLN阳性并行腋窝淋巴结清扫(ALND)的79例cT_(1~2)N_(0)M_(0)期浸润性乳腺癌患者的临床病理资料。分析患者临床病理特征与NSLN转移的相关性。结果79例患者中,58例(73.4%)行全乳切除术,61例(77.2%)为Luminal型,38例(48.1%)脉管浸润,64例(81.0%)1~2枚SLN阳性,行ALND后发现42例(53.2%)NSLN转移。单因素分析显示,脉管浸润组免疫组织化学诊断脉管浸润[86.8%(33/38)比51.2%(21/41)]、Ki-67阳性指数>30%[60.5%(23/38)比36.6%(15/41)]、人表皮生长因子受体2阳性[36.8%(14/38)比14.6%(6/41)]、淋巴结病理分期升期患者所占比例[57.9%(22/38)比31.7%(13/41)]较非脉管浸润组高(均P<0.05)。多因素logistic回归分析示,脉管浸润是NSLN转移的独立危险因素(OR=2.935,95%CI 1.081~7.970,P=0.035)。结论脉管浸润是SLN阳性cT_(1~2)N_(0)M_(0)期浸润性乳腺癌患者NSLN转移的独立危险因素,有助于指导腋窝局部处理决策的制订,避免治疗过度或不足。Objective To explore the relationship between lymphovascular invasion and non-sentinel lymph node(NSLN)metastasis in early-stage invasive breast cancer with positive sentinel lymph node(SLN)and its significance.Methods The clinicopathological data of 79 patients with stage cT_(1~2)N_(0)M_(0) invasive breast cancer who had positive SLN by biopsy and underwent axillary lymph node dissection(ALND)from January 2015 to February 2021 in the Central Hospital of Wuhan were retrospectively analyzed.The correlation between patients'clinicopathological characteristics and NSLN metastasis was analyzed.Results Among 79 patients,58 patients(73.4%)underwent total mastectomy,61 patients(77.2%)were Luminal type,38 patients(48.1%)had lymphovascular invasion,64 patients(81.0%)had 1-2 positive SLN,and 42 patients(53.2%)with NSLN metastasis were found after ALND.Univariate analysis showed that the proportions of patients with lymphovascular invasion diagnosed by immunohistochemistry[86.8%(33/38)vs.51.2%(21/41)],Ki-67 positive index>30%[60.5%(23/38)vs.36.6%(15/41)],positive human epidermal growth factor receptor 2[36.8%(14/38)vs.14.6%(6/41)],and elevated lymph node pathological staging[57.9%(22/38)vs.31.7%(13/41)]in the lymphovascular invasion group were higher than those in the non-lymphovascular invasion group(all P<0.05).Multivariate logistic regression analysis showed that lymphovascular invasion was an independent risk factor for NSLN metastasis(OR=2.935,95%CI 1.081-7.970,P=0.035).Conclusions Lymphovascular invasion is an independent risk factor for NSLN metastasis in SLN-positive stage cT_(1~2)N_(0)M_(0) invasive breast cancer.It may help to guide the decision-making of local axillary treatment,so as to avoid over or under treatment.

关 键 词：乳腺肿瘤 淋巴转移 脉管浸润 前哨淋巴结 非前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]