腋窝淋巴结外软组织状态对三阴性乳腺癌患者预后的影响  

Effect of extranodal extension of axillary lymph node metastasis on prognosis of patients with triple-negative breast cancer

作　　者：李岩[1] 王征[2] 张浩[2] LI Yan;WANG Zheng;ZHANG Hao(Graduate School of Xinxiang Medical University,Xinxiang,Henan 453003,P.R.China;Department of Breast Surgery,Nanyang Central Hospital,Nanyang,Henan 473000,P.R.China)

机构地区：[1]新乡医学院研究生院,河南新乡453003 [2]南阳市中心医院乳腺外科,河南南阳473000

出　　处：《中国普外基础与临床杂志》2024年第10期1258-1262,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：河南省自然科学基金(项目编号:222102310474)。

摘　　要：目的探讨腋窝淋巴结外软组织受累对三阴性乳腺癌(triple-negative breast cancer,TNBC)患者预后的影响。方法回顾性收集2017年1月至2019年1月期间南阳市中心医院收治的TNBC伴腋窝淋巴结转移患者,分析并比较腋窝淋巴结外软组织阳性和阴性TNBC患者的临床病理特征和预后情况并分析影响预后的因素。结果共纳入216例TNBC伴腋窝淋巴结转移患者,其中腋窝淋巴结外软组织阴性者123例、阳性者93例。相较于腋窝淋巴结外软组织阴性者,其阳性患者中组织学分级更高者(Ⅲ级)、淋巴结转移数目更多者(>10枚)、原发肿瘤直径更大者(>5 cm)占比更高(P<0.05)。多因素分析结果显示,淋巴结转移数目多(>10枚)是影响TNBC患者总生存期和无病生存期缩短的风险因素(P<0.05),腋窝淋巴结外软组织阳性是影响TNBC患者无病生存期缩短的风险因素(P<0.05),组织学分级高(Ⅲ级)和人类表皮生长因子受体2低表达是影响TNBC患者总生存期缩短的风险因素(P<0.05)。腋窝淋巴结外软组织阳性TNBC患者的5年累积无病生存率低于阴性患者且差异有统计学意义(70.2%比83.3%,χ^(2)=6.934,P=0.008),而二者的5年累积总生存率比较差异无统计学意义(75.3%比82.1%,χ^(2)=1.969,P=0.161)。结论从本研究结果看,TNBC患者中腋窝淋巴结外软组织阳性患者预后更差,尤其需多关注组织学分级Ⅲ级、淋巴结转移数目>10枚及人类表皮生长因子受体2低表达患者。Objective To investigate the effect of extranodal extension of axillary lymph nodes metastasis on the prognosis of patients with triple-negative breast cancer(TNBC).Methods The TNBC patients with axillary lymph node metastasis admitted to the Nanyang Central Hospital from January 2017 to January 2019 were collected.The clinicopathologic characteristics and prognosis of TNBC patients with or without extranodal extension were analyzed and compared,and the factors affecting prognosis were analyzed.Results A total of 216 patients were included,including 123 patients without extranodal extension and 93 patients with extranodal extension.Compared with the patients without extranodal extension,the proportions of the patients with histological gradeⅢ,10 or more metastatic lymph nodes,and 5 cm or greater tumor diameter were higher in the patients with extranodal extension(P<0.05).The results of multivariate analysis showed that the 10 or more metastatic lymph nodes was the risk factor affecting the overall survival(OS)and disease-free survival(DFS)of the TNBC patients(P<0.05),and the histological gradeⅢand lower human epidermal growth factor receptor-2(HER-2)expression were the risk factors affecting the OS of the TNBC patients(P<0.05),as well as the extranodal extension was the risk factor affecting the DFS of the TNBC patients(P<0.05).The 5-year cumulative disease-free survival rate of the patients with extranodal extension was worse than that of the patients without extranodal extension(70.2%vs.83.3%,χ^(2)=6.934,P=0.008).The 5-year cumulative overall survival rate had no statistically significant difference between the them(75.3%vs.82.1%,χ^(2)=1.969,P=0.161).Conclusions From the results of this study,the prognosis of TNBC patients with extranodal extension is worse.Especially the patients with histological gradeⅢ,10 or more metastatic lymph nodes,and with lower HER-2 expression should be paid attention.

关 键 词：三阴性乳腺癌 腋窝淋巴结外软组织 临床病理特征 无病生存 总生存 

分 类 号：R737.9[医药卫生—肿瘤]