行全乳切除术的 1-2 枚前哨淋巴结宏转移乳腺癌非前哨淋巴结转移的风险因素：一项病例对照研究。

Risk factors of non-sentinel lymph node metastasis in breast cancer with 1-2 sentinel lymph node macrometastases underwent total mastectomy: a case-control study.

机构信息

Department of Breast Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 53002, China.

Department of Gynaecology, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China.

出版信息

World J Surg Oncol. 2023 Apr 6;21(1):125. doi: 10.1186/s12957-023-02888-z.

DOI:10.1186/s12957-023-02888-z

PMID:37024930

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10077622/

Abstract

BACKGROUND

The randomized trials which include ACOSOG Z0011 and IBCSG 23-01 had found that the survival rates were not different in patients with cT1/2N0 and 1-2 sentinel lymph node (SLN)-positive, macro/micrometastases who underwent breast-conserving therapy, and micrometastases who underwent total mastectomy (TM), when axillary lymph node dissection (ALND) was omitted. However, for patients with cT1/2N0 and 1-2 SLN macrometastases who underwent TM; there was still insufficient evidence from clinical studies to support whether ALND can be exempted. This study aimed to investigate the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1-2 SLN macrometastases undergoing TM.

METHODS

The clinicopathological data of 1491 breast cancer patients who underwent TM and SLNB from January 2017 to February 2022 were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for nSLN metastasis.

RESULTS

A total of 273 patients with 1-2 SLN macrometastases who underwent TM were enrolled. Postoperative pathological data showed that 35.2% patients had nSLN metastasis. The results of multivariate analysis indicated that tumor size (TS) (P = 0.002; OR: 1.051; 95% CI: 1.019-1.084) and ratio of SLN macrometastases (P = 0.0001; OR: 12.597: 95% CI: 4.302-36.890) were the independent risk factors for nSLN metastasis in breast cancer patients with 1-2 SLN macrometastases that underwent TM. The ROC curve analysis suggested that when TS ≤22 mm and ratio of SLN macrometastases ≤0.33, the incidence of nSLN metastasis could be reduced to 17.1%.

CONCLUSIONS

The breast cancer patients with cT1/2N0 stage, undergoing TM and 1-2 SLN macrometastases, when the TS ≤22 mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, but whether ALND can be exempted needs further exploration.

摘要

背景

ACOSOG Z0011 和 IBCSG 23-01 这两项随机试验发现，对于接受保乳治疗的 cT1/2N0 期和 1-2 枚前哨淋巴结（SLN）阳性、宏/微转移，以及接受全乳切除术（TM）的微转移患者，若省略腋窝淋巴结清扫术（ALND），其生存率并无差异。然而，对于接受 TM 且 1-2 枚 SLN 大转移的 cT1/2N0 期患者，临床研究仍缺乏支持豁免 ALND 的充分证据。本研究旨在探讨 1-2 枚 SLN 大转移行 TM 的乳腺癌患者非前哨淋巴结（nSLN）转移的危险因素。

方法

回顾性分析 2017 年 1 月至 2022 年 2 月期间接受 TM 和 SLNB 的 1491 例乳腺癌患者的临床病理资料。采用单因素和多因素分析方法分析 nSLN 转移的危险因素。

结果

共纳入 273 例 1-2 枚 SLN 大转移且行 TM 的患者。术后病理资料显示，35.2%的患者存在 nSLN 转移。多因素分析结果表明，肿瘤大小（TS）（P=0.002；OR：1.051；95%CI：1.019-1.084）和 SLN 大转移比例（P=0.0001；OR：12.597：95%CI：4.302-36.890）是 1-2 枚 SLN 大转移行 TM 的乳腺癌患者 nSLN 转移的独立危险因素。ROC 曲线分析提示，当 TS≤22mm 且 SLN 大转移比例≤0.33 时，nSLN 转移的发生率可降低至 17.1%。