Department of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
World J Surg Oncol. 2024 Sep 28;22(1):258. doi: 10.1186/s12957-024-03537-9.
Axillary lymph node dissection (ALND) is the standard axillary management for breast cancer patients with positive sentinel lymph node biopsy (SLNB) after neoadjuvant therapy. Nevertheless, when that happens, the frequency of additional positive nodes is not properly evaluated. We aim to develop a prediction model to assess the frequency of additional nodal disease after a positive sentinel lymph node following neoadjuvant therapy.
We retrospectively analyzed the ultrasound and clinicopathological characteristics of breast cancer patients with 1-3 positive sentinel lymph nodes (SLN) undergoing mastectomy after neoadjuvant therapy (NAT) at our institution, and performed univariate and multivariate logistic analyses to confirm the factors affecting non-SLN metastasis. These factors were included to establish a nomogram, and the area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were utilized to assess the validity of this model.
A total of 126 breast cancer patients were ultimately included in our study, 38 (53.5%) patients were diagnosed with non-SLN metastases of all 71 patients in training set. The results of multifactorial logistic analysis suggested that lymph node metastasis ratio (LNR), short axis of lymph node and progesterone receptor (PR) were strongly associated with non-SLN metastasis. We established a nomogram using the above three variables as predictors, which yielded an area under the curve of 0.795, and validated with a favorable AUC of 0.876.
The nomogram we constructed can accurately predict the likelihood of non-SLN metastasis in our patients with 1-3 positive SLN after NAT, which may help guide decision making regarding axillary management.
腋窝淋巴结清扫术（ALND）是新辅助治疗后前哨淋巴结活检（SLNB）阳性的乳腺癌患者的标准腋窝管理方法。然而，当这种情况发生时，并未对额外阳性淋巴结的频率进行适当评估。我们旨在开发一种预测模型，以评估新辅助治疗后阳性前哨淋巴结（SLN）后额外淋巴结疾病的频率。
我们回顾性分析了在我们机构接受新辅助治疗（NAT）后行乳房切除术的 1-3 个阳性 SLN 的乳腺癌患者的超声和临床病理特征，并进行了单因素和多因素逻辑分析，以确认影响非 SLN 转移的因素。将这些因素纳入建立列线图，并利用接受者操作特征曲线（AUC）和决策曲线分析（DCA）评估该模型的有效性。
共有 126 例乳腺癌患者最终纳入我们的研究，38 例（53.5%）患者在训练集中的 71 例患者中被诊断为非 SLN 转移。多因素逻辑分析的结果表明，淋巴结转移率（LNR）、淋巴结短轴和孕激素受体（PR）与非 SLN 转移密切相关。我们使用上述三个变量作为预测因子建立了一个列线图，该图的曲线下面积为 0.795，并通过验证得到了 0.876 的有利 AUC。
我们构建的列线图可以准确预测新辅助治疗后 1-3 个阳性 SLN 的患者非 SLN 转移的可能性，这可能有助于指导腋窝管理的决策。
