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目的 :探讨前哨淋巴结(SLN)活检1~2枚转移乳腺癌病人非前哨淋巴结(NSLN)转移的预测因素。方法 :收集2011年1月至2017年6月本院乳腺疾病诊治中心cT_(1~2)N_0女性乳腺癌病例,SLN活检提示SLN 1~2枚转移,进一步行腋窝淋巴结清扫(ALND)共263例。回顾性分析NSLN转移的预测因素。结果:单因素分析结果显示,肿块大小(P=0.024)、脉管癌栓(P=0.038)、SLN阳性个数/与SLN活检个数比值(SLN+/SLN,P<0.001)和术前超声ALN异常状态(P=0.020)是NSLN转移的预测因素。多因素Logistic回归分析结果显示,肿块最大径>2 cm(OR=1.97,95%CI:1.08~3.60,P=0.028)、SLN+/SLN比值≥0.5(OR=3.00,95%CI:1.65~5.48,P<0.001),术前超声ALN异常(OR=1.93,95%CI:1.03~3.63,P=0.041)是NSLN转移的独立预测因素。具有0、1、2或3项独立预测因素的病人,NSLN转移率分别为10.1%、21.3%、36.5%和58.3%。结论:对于cT_(1~2)N_0、SLN 1~2枚转移的乳腺癌病人,肿块大小、SLN+/SLN比值和术前超声ALN异常状态是NSLN转移的独立预测因素。同时具有≥2项独立预测因素的病人,NSLN转移率较高,在免除ALND时应慎重考虑。
Objective: To investigate the predictors of non-sentinel lymph node (NSLN) metastasis in patients with metastatic breast cancer from SLN biopsies. Methods: The cases of cT_ (1 ~ 2) N_0 breast cancer in our hospital from January 2011 to June 2017 were collected. SLN biopsy showed 1 ~ 2 SLN metastases and further axillary lymph node dissection (ALND) of 263 example. The predictors of NSLN metastasis were retrospectively analyzed. Results: The results of univariate analysis showed that the size of the tumor (P = 0.024), the tumor thrombus (P = 0.038), the number of SLN positive / SLN biopsy (SLN + / SLN, P <0.001) Abnormal ALN status (P = 0.020) was a predictor of NSLN metastasis. Multivariate Logistic regression analysis showed that the maximum diameter of tumor was> 2 cm (OR = 1.97, 95% CI: 1.08-3.60, P = 0.028) and the ratio of SLN + / SLN was 0.5 (OR = 3.00, 95% CI: 1.65-5.48 , P <0.001). Preoperative ultrasound ALN abnormalities (OR = 1.93, 95% CI: 1.03-3.63, P = 0.041) were independent predictors of NSLN metastasis. Patients with 0, 1, 2, or 3 independent predictors had NSLN rates of 10.1%, 21.3%, 36.5%, and 58.3%, respectively. CONCLUSIONS: The size of the tumor, the ratio of SLN + / SLN, and the preoperative ALN abnormality are independent predictors of NSLN metastasis in breast cancer patients with cT_ (1 ~ 2) N_0 and SLN metastases. Patients with ≥2 independent predictors at the same time have a higher rate of NSLN metastases and should be carefully considered when avoiding ALND.