Yang C L, Li J B, Wang W, Wang X, Zhang Y J, Shao Q, Wang J Z
Graduate College, Shandong First Medical University and Shandong Academy of Sciences, Jinan 250117, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China.
Zhonghua Zhong Liu Za Zhi. 2022 May 23;44(5):410-415. doi: 10.3760/cma.j.cn112152-20210713-00510.
To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.
探讨影像检查内乳淋巴结（IMN）阴性的乳腺癌患者IMN转移的独立危险因素及术前IMN转移的风险评估方法，指导不同IMN转移风险分层患者的IMN放疗。回顾性分析2010年1月至2019年10月在山东省肿瘤医院接受内乳前哨淋巴结活检（IM-SLNB）和/或IMN清扫且CT和/或MRI显示IMN阴性的301例乳腺癌患者的临床和病理资料。采用单因素和多因素logistic回归分析独立危险因素，并将IMN转移的独立危险因素用于风险分层。301例患者中，43例发生IMN转移，IMN转移率为14.3%。单因素分析显示，血管内肿瘤血栓、孕激素受体（PR）表达、T分期和N分期与IMN转移有关。多因素logistic回归分析显示，肿瘤位于内象限、PR阳性和腋窝淋巴结转移是IMN转移的独立危险因素。根据患者的独立危险因素评估IMN转移风险：低风险组为无危险因素，中风险组为有1个危险因素，高风险组为有2 - 3个危险因素。根据该评估标准，将301例乳腺癌患者分为低风险组（无危险因素）、中风险组（有1个危险因素）和高风险组（有2 - 3个危险因素），IMN转移率分别为0（0/34）、4.3%（6/140）和29.1%（37/127）。根据乳腺癌患者IMN转移的三个独立危险因素（肿瘤位于内象限、PR阳性和腋窝淋巴结转移）进行IMN转移风险分层，可指导初诊乳腺癌患者的IMN放疗。对于N1患者，当原发肿瘤位于内象限和/或PR阳性时，强烈推荐IMN放疗。
