Degnim Amy C, Griffith Kent A, Sabel Michael S, Hayes Daniel F, Cimmino Vincent M, Diehl Kathleen M, Lucas Peter C, Snyder Matthew L, Chang Alfred E, Newman Lisa A
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Cancer. 2003 Dec 1;98(11):2307-15. doi: 10.1002/cncr.11803.
In breast carcinoma patients with a positive sentinel lymph node (SN), the value of complete axillary lymph node dissection has been questioned. Multiple published reports have attempted to identify clinicopathologic characteristics of the primary tumor and SN that are associated with an increased likelihood of positive nonsentinel lymph nodes (NSN). Because of differences in lymph node evaluation techniques and limited patient numbers in each study, the authors performed a meta-analysis to assess the regularity and relative strength of association between various characteristics and the risk of NSN metastasis.
A MEDLINE search identified 15 candidate studies, 11 of which met the criteria for analysis. General elements of the studies, the pathologic characteristics evaluated, and the results for selected characteristics were compared. Original data were abstracted from each study and used to calculate odds ratios. The Mantel-Haenszel common odds ratios were calculated to determine the relative strength of the associations.
Despite methodologic differences, the correlation between positive NSNs and certain pathologic characteristics was found to be remarkably similar among studies. The 5 individual characteristics found to be associated with the highest likelihood of NSN metastasis are SN metastasis > 2 mm in size, extranodal extension in the SN, tumor size > 2 cm, > 1 positive SN, and lymphovascular invasion in the primary tumor.
There is general concordance among studies regarding the association between pathologic characteristics and NSN metastasis in breast carcinoma patients with a positive SN. The pooled analysis identified those factors with the strongest associations that should be evaluated routinely in SN specimens and included in prospective databases for the development of a predictive model.
在前哨淋巴结（SN）阳性的乳腺癌患者中，腋窝淋巴结清扫术的价值受到质疑。多篇已发表的报告试图确定与非前哨淋巴结（NSN）阳性可能性增加相关的原发肿瘤和SN的临床病理特征。由于各研究中淋巴结评估技术存在差异且患者数量有限，作者进行了一项荟萃分析，以评估各种特征与NSN转移风险之间关联的规律性和相对强度。
通过医学文献数据库（MEDLINE）检索确定了15项候选研究，其中11项符合分析标准。比较了各研究的一般要素、评估的病理特征以及选定特征的结果。从每项研究中提取原始数据并用于计算比值比。计算Mantel-Haenszel共同比值比以确定关联的相对强度。
尽管存在方法学差异，但各研究中NSN阳性与某些病理特征之间的相关性非常相似。发现与NSN转移可能性最高相关的5个个体特征为：SN转移灶大小>2mm、SN有结外扩展、肿瘤大小>2cm、有1个以上阳性SN以及原发肿瘤有淋巴管浸润。
对于SN阳性的乳腺癌患者，各研究在病理特征与NSN转移之间的关联方面总体上具有一致性。汇总分析确定了那些关联最强的因素，应在前哨淋巴结标本中进行常规评估，并纳入前瞻性数据库以建立预测模型。
