Bolster Marieke J, Peer Petronella G M, Bult Peter, Thunnissen Frederik B J M, Schapers René F M, Meijer Jos W R, Strobbe Luc J A, van Berlo Charles L H, Klinkenbijl Jean H G, Beex Louk V A M, Wobbes Theo, Tjan-Heijnen Vivianne C G
Department of Surgery, Radboud University Nijmegen Medical Center (MC), Nijmegen, The Netherlands.
Ann Surg Oncol. 2007 Jan;14(1):181-9. doi: 10.1245/s10434-006-9065-1. Epub 2006 Oct 7.
In this multi-institutional prospective study, we evaluated whether we could identify risk factors predictive for non-sentinel lymph node (non-SN) metastases in breast cancer patients with a positive sentinel lymph node (SN).
In this multi-institutional study, 541 eligible breast cancer patients were included prospectively.
The occurrence of non-SN metastases was related to the size of the SN metastasis (P = .02), primary tumor size (P = .001), and lymphovascular invasion (P = .07). The adjusted odds ratio was 3.1 for SN micro-metastasis compared with SN isolated tumor cells, 4.0 for SN macro-metastasis versus SN isolated tumor cells, 3.1 for tumor size (>3.0 cm compared with </=3.0 cm), and 2.0 for lymphovascular invasion (yes versus no). There were no positive non-SNs when the primary tumor size was </=1.0 cm (n = 24) [95% confidence interval (95% CI) 0%-14.0%]. The proportion of positive non-SNs ranged in a prognostic logistic regression model from 9.7% (95% CI 4.0%-23.0%) for patients with SN isolated tumor cells, tumor size of 1.1-3.0 cm, and without vessel invasion, to 72.6% (95% CI 47.0%-89.0%) for patients with SN macro-metastasis, tumor size >3.0 cm, and with vessel invasion.
We identified three predictive factors for non-SN metastases in breast cancer patients with a positive SN: size of the SN metastasis; primary tumor size; and vessel invasion. We were not able to identify a specific group of patients with a positive SN in whom the risk for non-SN metastases was less than 5%.
在这项多机构前瞻性研究中，我们评估了能否识别前哨淋巴结（SN）阳性的乳腺癌患者非前哨淋巴结（非SN）转移的预测风险因素。
在这项多机构研究中，前瞻性纳入了541例符合条件的乳腺癌患者。
非SN转移的发生与SN转移灶大小（P = 0.02）、原发肿瘤大小（P = 0.001）和淋巴管侵犯（P = 0.07）有关。与SN孤立肿瘤细胞相比，SN微转移的校正比值比为3.1，SN宏转移与SN孤立肿瘤细胞相比为4.0，肿瘤大小（>3.0 cm与≤3.0 cm相比）为3.1，淋巴管侵犯（是与否）为2.0。当原发肿瘤大小≤1.0 cm（n = 24）时，无阳性非SN（95%置信区间[95%CI] 0% - 14.0%）。在预后逻辑回归模型中，非SN阳性比例范围为：SN孤立肿瘤细胞、肿瘤大小1.1 - 3.0 cm且无血管侵犯的患者为9.7%（95%CI 4.0% - 23.0%），至SN宏转移、肿瘤大小>3.0 cm且有血管侵犯的患者为72.6%（95%CI 47.0% - 89.0%）。
我们识别出前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移的三个预测因素：SN转移灶大小；原发肿瘤大小；以及血管侵犯。我们未能识别出一组前哨淋巴结阳性且非前哨淋巴结转移风险小于5%的特定患者群体。
