Wang Xuefei, Zhang Guochao, Zuo Zhichao, Zhu Qingli, Wu Shafei, Zhou Yidong, Mao Feng, Lin Yan, Shen Songjie, Zhang Xiaohui, Qin Xue, Yan Cunli, Ma Xiaoying, Shi Yue, Sun Qiang
Breast Surgery Department, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College and Hospital, Beijing, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College.
J Surg Res. 2022 Mar;271:59-66. doi: 10.1016/j.jss.2021.09.039. Epub 2021 Nov 25.
To investigate retrospectively an association between the number of metastatic sentinel lymph nodes (SLNs) per total number of SLNs per patient (i.e., the SLN positive rate, or SLN-PR) and non-SLN metastasis in breast cancer.
A large population (n = 2250) underwent SLN dissection from January 1, 2014 to January 1, 2020; 627 (27.87%) had at least one positive SLN (SLN). Among these, 283 underwent axillary lymph node (ALN) dissection, and formed the test group. Four external validation groups comprised 43 patients treated in 2019. SLN mappings were examined using methylene blue and indocyanine green. Lymph node ultrasound, SLN-PR, and pathological characteristics were compared between patients with and without non-SLN metastasis. An SLN-PR cutoff value was calculated using receiver operating characteristic (ROC) curves. Associations between clinicopathological variables and SLN-PR with non-SLN metastasis were analyzed by multivariate logistic regression model.
The median age was 47 years (IQR: 42-56 y). The median number of resected SLNs was 4. Patients with positive non-SLNs (126/283, 44.52%) had a median of 2 positive node. SLN-PR > 0.333 was a risk factor for non-SLN positivity (area under the ROC curve, 0.726); and carried significantly higher risk of non-SLN metastasis (P < 0.001). This was validated in the external group.
SLN-PR > 0.333 was associated with greater risk of non-SLN metastasis. This provides a reference to non-SLN metastasis in patients with SLN metastasis, an indication for ALN dissection and choice of adjuvant treatment.
回顾性研究每位乳腺癌患者前哨淋巴结（SLN）转移数量占SLN总数的比例（即SLN阳性率，或SLN-PR）与非SLN转移之间的关联。
2014年1月1日至2020年1月1日期间，一大群患者（n = 2250）接受了SLN清扫术；其中627例（27.87%）至少有一枚SLN转移（SLN阳性）。在这些患者中，283例接受了腋窝淋巴结（ALN）清扫术，组成试验组。四个外部验证组由2019年接受治疗的43例患者组成。使用亚甲蓝和吲哚菁绿检查SLN定位。比较有和无非SLN转移患者的淋巴结超声、SLN-PR及病理特征。使用受试者工作特征（ROC）曲线计算SLN-PR的截断值。通过多因素逻辑回归模型分析临床病理变量和SLN-PR与非SLN转移之间的关联。
中位年龄为47岁（四分位间距：42 - 56岁）。切除的SLN中位数为4枚。非SLN阳性患者（126/283，44.52%）的转移淋巴结中位数为2枚。SLN-PR > 0.333是非SLN阳性的危险因素（ROC曲线下面积，0.726）；且非SLN转移风险显著更高（P < 0.001）。这在外部验证组中得到了验证。
SLN-PR > 0.333与非SLN转移风险增加相关。这为SLN转移患者的非SLN转移情况、ALN清扫术指征及辅助治疗选择提供了参考。
