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目的研究前哨淋巴结(sentinel lymph node,SLN)阳性乳腺癌患者腋窝非前哨淋巴结(NSLN)转移的危险因素,验证纪念斯隆-凯特琳癌症中心(MSKCC)腋窝NSLN转移预测模型评估乳腺癌患者的临床应用价值。方法回顾性地分析军事医学科学院附属医院普外科2000年1月至2011年3月175例成功行SLN活检且结果阳性、随即行腋窝淋巴结清扫的乳腺癌患者临床病理资料,使用MSKCC预测模型计算每例患者腋窝NSLN转移风险,利用校正曲线和受试者操作特性曲线(ROC)下面积(AUC)评估该模型预测的准确性。结果原发肿瘤大小、肿瘤是否多发、阳性SLN数、阳性SLN转移率、阴性SLN数与腋窝NSLN转移相关,P值分别为0.0018、0.0029、0.0049、0.0007、0.0002。多因素Logistic回归分析发现,原发肿瘤大小、肿瘤是否多发和阳性SLN数是NSLN转移的独立危险因素,P值分别为0.0022、0.0160、0.0176。校正曲线显示预测值曲线和真实值曲线趋势相近,MSKCC预测模型被验证的AUC值为0.79。结论对于SLN转移阳性的乳腺癌患者,原发肿瘤越小、肿瘤单发、阳性SLN数越少、阴性SLN数越多、阳性SLN转移率越低,其腋窝NSLN转移可能性越低,可对是否行腋窝淋巴结清扫提供参考。MSKCC预测模型可较准确地预测腋窝NSLN的转移风险。
Objective To study the risk factors of non-sentinel lymph node (NSLN) metastases in axillary lymph nodes in sentinel lymph node (SLN) positive breast cancer patients and to verify the clinical evaluation of axillary NSLN metastasis predictive models of Memorial Sloan-Kettering Cancer Center (MSKCC) in patients with breast cancer Value. Methods The clinicopathological data of breast cancer patients with successful SLN biopsy and positive axillary lymph node dissection were retrospectively analyzed from January 2000 to March 2011 in General Surgery Affiliated Hospital of Academy of Military Medical Sciences using the MSKCC prediction model Patients with axillary NSLN metastases were assessed for accuracy using the calibration curve and receiver operating characteristic (ROC) area under the curve (AUC). Results Primary tumor size, multiple tumor occurrence, positive SLN number, positive SLN metastasis rate and negative SLN number were correlated with axillary NSLN metastasis, with P values of 0.0018,0.0029,0.0049,0.0007,0.0002 respectively. Multivariate Logistic regression analysis showed that primary tumor size, multiple tumor occurrence and positive SLN number were independent risk factors of NSLN metastasis, P values were 0.0022,0.0160,0.0176 respectively. The calibration curve shows that the trend of the predicted value curve and the true value curve are similar, and the AUC value of the MSKCC prediction model is 0.79. Conclusion For patients with SLN-positive breast cancer, the smaller the primary tumor, the lesser the number of SLNs, the lower the number of positive SLNs, the lower the positive SLNs, and the lower the metastasis potential of axillary NSLNs Whether axillary lymph node dissection provide a reference. The MSKCC prediction model can predict the metastatic risk of axillary NSLN more accurately.