University of Cambridge, Cambridge, UK.
Cambridge University Hospitals, Cambridge, CB2 0QQ, UK.
Breast Cancer Res Treat. 2024 May;205(1):109-116. doi: 10.1007/s10549-023-07230-5. Epub 2024 Feb 3.
Understanding the factors influencing nodal status in breast cancer is vital for axillary staging, therapy, and patient survival. The nodal stage remains a crucial factor in prognostication indices. This study investigates the relationship between tumour-to-skin distance (in T1-T3 tumours where the skin is not clinically involved) and the risk of nodal metastasis.
We retrospectively reviewed data from 100 patients who underwent neoadjuvant chemotherapy (NACT). Besides patient demographics and tumour variables, a radiologist retrospectively reviewed pre-operative MRI to measure tumour-to-skin distance. R core packages were used for univariate (χ2 and T-Wilcoxon tests) and bivariate logistic regression statistical analysis.
Of 95 analysable datasets, patients' median age was 51 years (IQR: 42-61), 97% were symptomatic (rest screen detected), and the median tumour size was 43 mm (IQR, 26-52). On multivariate analysis, increasing invasive tumour size (p = 0.02), ER positivity (p = 0.007) and shorter tumour-to-skin distance (p = 0.05) correlated with nodal metastasis. HER2 was not included in multivariate analysis as there was no association with nodal status on univariate analysis. In node-positive tumours, as tumour size increased, the tumour-to-skin distance decreased (r = - 0.34, p = 0.026). In node-negative tumours, there was no correlation (r = + 0.18, p = 0.23).
This study shows that non-locally advanced cancers closer to the skin (and consequent proximity to subdermal lymphatics) are associated with a greater risk of nodal metastasis. Pre-operative identification of those more likely to be node positive may suggest the need for a second-look USS since a higher nodal stage may lead to a change in therapeutic strategies, such as upfront systemic therapy, node marking, and axillary clearance without the need to return to theatre following sentinel node biopsy.
了解乳腺癌淋巴结状态的影响因素对腋窝分期、治疗和患者生存至关重要。淋巴结分期仍然是预后指数的一个关键因素。本研究调查了肿瘤-皮肤距离（在 T1-T3 肿瘤中，皮肤未临床受累）与淋巴结转移风险之间的关系。
我们回顾性分析了 100 例接受新辅助化疗（NACT）的患者的数据。除了患者人口统计学和肿瘤变量外，放射科医生还回顾性地分析了术前 MRI 以测量肿瘤-皮肤距离。使用 R 核心包进行单变量（χ2 和 T-Wilcoxon 检验）和双变量逻辑回归统计分析。
在 95 个可分析数据集，患者的中位年龄为 51 岁（IQR：42-61），97%为有症状（筛查发现），肿瘤大小的中位数为 43mm（IQR：26-52）。在多变量分析中，侵袭性肿瘤大小增加（p=0.02）、ER 阳性（p=0.007）和肿瘤-皮肤距离缩短（p=0.05）与淋巴结转移相关。由于在单变量分析中与淋巴结状态无关联，因此未将 HER2 纳入多变量分析。在淋巴结阳性肿瘤中，随着肿瘤大小的增加，肿瘤-皮肤距离减小（r=-0.34，p=0.026）。在淋巴结阴性肿瘤中，无相关性（r=+0.18，p=0.23）。
本研究表明，靠近皮肤的非局部晚期癌症（因此与皮下淋巴管更接近）与淋巴结转移风险增加相关。术前识别那些更有可能出现淋巴结阳性的患者可能提示需要进行第二次超声检查，因为更高的淋巴结分期可能导致治疗策略的改变，例如 upfront 全身治疗、淋巴结标记和无需在前哨淋巴结活检后返回手术室即可进行腋窝清扫。
