早期乳腺癌前哨淋巴结转移的风险因素分析  

Risk factors of sentinel lymph node metastasis in early-stage breast cancer

作　　者：段志财 陈建哲 熊洁 吕兴 左怀全 DUAN Zhicai;CHEN Jianzhe;XIONG Jie;LÜXing;ZUO Huaiquan(Department of Breast Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan Province 646000,P.R.China)

机构地区：[1]西南医科大学附属医院乳腺外科,四川泸州646000

出　　处：《中国普外基础与临床杂志》2025年第3期354-358,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨临床分期为N0的早期乳腺癌患者前哨淋巴结(sentinel lymph node,SLN)转移的危险因素,建立SLN转移的预测模型,以协助临床工作中的腋窝手术决策。方法回顾性收集2020年9月至2023年12月期间于西南医科大学附属医院接受手术治疗并行SLN活检的单侧早期乳腺癌患者作为研究对象,采用单因素分析和多因素logistic回归分析SLN转移的风险因素并构建SLN转移风险的预测模型,同时采用受试者操作特征曲线下面积(area under receiver operating characteristic curve,AUC)评估预测模型区分SLN发生转移的能力。结果本研究共收集到符合纳入标准的早期乳腺癌患者351例,其中有136例SLN转移,转移率为38.7%。多因素logistical回归分析结果显示,肿瘤最大径>2.5 cm、雌激素受体(estrogen receptor,ER)状态阳性、Ki-67值>20%及有脉管侵犯患者的SLN转移概率更大[肿瘤最大径>2.5 cm:OR(95%CI)=1.897(1.186,3.034),P=0.008;ER状态阳性:OR(95%CI)=2.721(1.491,4.967),P=0.001;Ki-67值>20%:OR(95%CI)=1.825(1.125,2.960),P=0.015;有脉管侵犯:OR(95%CI)=2.858(1.641,4.976),P<0.001],这四者联合判断SLN发生转移的AUC为0.693(0.637,0.749),其敏感度和特异度分别为70.59%、57.21%。结论从本研究结果提示,对于肿瘤最大径>2.5 cm、ER阳性、Ki-67值>20%及脉管侵犯的早期乳腺癌患者建议进行SLN活检,以指导术后辅助治疗策略,但本研究中以此构建的预测模型对发生SLN转移的区分能力一般,今后可进一步分析原因。Objective To explore the risk factors affecting sentinel lymph node(SLN)metastasis in patients with early-stage(N0)breast cancer and establish a predictive model for SLN metastasis,so as to assist in decision-making of axillary surgery in clinical practice.Methods The unilateral early-stage breast cancer patients who underwent surgical treatment and SLN biopsy at the Affiliated Hospital of Southwest Medical University from September 2020 to December 2023 were selected as the study subjects.The univariate and multivariable logistic regression analyses were adopted to analyze the relevant risk factors of SLN metastasis,then a predictive model evaluating the risk of SLN metastasis was constructed.The area under receiver operating characteristic curve(AUC)was used to assess the distinguishing ability of risk factors for SLN metastasis.Results A total of 351 patients with early-stage breast cancer patients who met the inclusion criteria were enrolled,136 of whom with SLN metastasis,the SLN metastasis rate was 38.7%.The results of the multivariate logistic regression analysis showed that the maximum tumor diameter>2.5 cm,estrogen receptor(ER)positive,Ki-67>20%,and vascular invasion were the risk factors affecting SLN metastasis[maximum tumor diameter:OR(95%CI)=1.897(1.186,3.034),P=0.008;ER positive:OR(95%CI)=2.721(1.491,4.967),P=0.001;Ki-67>20%:OR(95%CI)=1.825(1.125,2.960),P=0.015;vascular invasion:OR(95%CI)=2.858(1.641,4.976),P<0.001].The AUC for the SLN metastasis by these four factors was 0.693(0.637,0.749),with a sensitivity and specificity of 70.59%and 57.21%,respectively.Conclusions The results from this study suggest that SLN biopsy is recommended to guide postoperative adjuvant treatment strategies for cN0 early-stage breast cancer patients with a maximum tumor diameter>2.5 cm,ER positivity,Ki-67>20%,and vascular invasion.However,the predictive model constructed based on these four factors in this study has a general ability to distinguish the occurrence of SLN metastasis,then the reasons can be further analyze

关 键 词：早期乳腺癌 前哨淋巴结活检 风险因素 

分 类 号：R73[医药卫生—肿瘤]