Patel Pinakin, Kumar Naina, Babu Agil, Gupta Ajay, Lakhera Kamal Kishore, Singh Suresh, Kumar Arjun, Faujdar Mansi, Singhal Pranav, Gora Bhoopendra Singh
Department of Surgical Oncology, SMS Medical College and Attached Group of Hospitals, B 31 Prabhu Marg Tilak Nagar, Jaipur, 302004 India.
Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian J Surg Oncol. 2024 Dec;15(4):768-776. doi: 10.1007/s13193-024-01987-x. Epub 2024 Jun 19.
Prognostic factors by definition, are capable of providing information on clinical outcomes at the time of diagnosis, independent of therapy. The number of positive lymph nodes (number of ipsilateral axillary nodes with metastatic tumour deposits) is a strong and independent prognostic factor in breast cancer. In a meta-analysis (, 2017) of over 62,000 patients, the risk of distant recurrence over years 5 to 20 for those with T1 tumours was 13% in the absence of lymph node involvement, 20% among those with one to three involved lymph nodes, and 34% among those with four to nine involved nodes. In this study, we analyzed the association of clinicopathological factors and breast cancer subtypes with axillary lymph node (ALN) positivity in women with breast cancer in Rajasthan. A multivariate Logistic (Ordinal) Regression Model was used to predict the number of positive lymph nodes based on independent variables that showed 90% significance in bivariate analysis, such as total number of lymph nodes dissected, tumour necrosis, and lymphovascular invasion. The Wald criterion indicated that only LVI had a significant impact on the prediction ( < 0.05), while tumour necrosis and the total number of lymph nodes dissected were not significant predictors ( > 0.05). Patients with LVI had a 43.47 times higher risk of having positive lymph nodes ( < 0.05). Early prediction of lymph node metastasis through LVI testing can help in prognostication. Breast cancer subtypes should not be a criterion while deciding lymph nodal management.
根据定义，预后因素能够在诊断时提供有关临床结局的信息，且与治疗无关。阳性淋巴结数量（有转移性肿瘤沉积物的同侧腋窝淋巴结数量）是乳腺癌中一个强有力的独立预后因素。在一项对超过62000名患者的荟萃分析（，2017年）中，T1期肿瘤患者在无淋巴结受累情况下5至20年远处复发风险为13%，有1至3个受累淋巴结的患者为20%，有4至9个受累淋巴结的患者为34%。在本研究中，我们分析了拉贾斯坦邦乳腺癌女性患者的临床病理因素和乳腺癌亚型与腋窝淋巴结（ALN）阳性之间的关联。使用多变量逻辑（有序）回归模型，基于在双变量分析中显示90%显著性的自变量来预测阳性淋巴结数量，如切除的淋巴结总数、肿瘤坏死和淋巴管浸润。Wald检验表明只有淋巴管浸润对预测有显著影响（<0.05），而肿瘤坏死和切除的淋巴结总数不是显著的预测因素（>0.05）。有淋巴管浸润的患者出现阳性淋巴结的风险高43.47倍（<0.05）。通过淋巴管浸润检测早期预测淋巴结转移有助于预后评估。在决定淋巴结处理时，乳腺癌亚型不应作为一个标准。
