前哨淋巴结活检阳性乳腺癌患者避免腋窝淋巴结清扫的探讨

Predictive factors of avoiding axillary lymph node dissection in breast cancer patients with positive result of sentinel lymph node

  • 摘要: 目的 探讨前哨淋巴结活检(sentinel lymph node biopsy,SLNB)阳性乳腺癌患者避免进一步腋窝淋巴结清扫的预测因子。 方法 收集解放军总医院2007年1月- 2016年11月行SLNB的乳腺癌患者临床资料并进行回顾性分析,探讨SLNB阳性患者避免进一步腋窝淋巴结清扫的预测因子。 结果 196例SLNB阳性患者中,121例(61.7%)腋窝淋巴结清扫(axillary lymph node dissection,ALND)结果阴性,75例结果阳性。单因素分析筛选出P< 0.1的因素4个:年龄(P=0.062)、组织学分级(P=0.009)、阳性前哨淋巴结数目(P=0.002)和病理T分期(P=0.078)。多因素分析显示,阳性前哨淋巴结数目(≥3 vs 1,OR=4.159,P=0.003)和组织学分级(ⅢvsⅠ,OR=2.287,P=0.011)对进一步行ALND的病理结果有指示意义。 结论 对前哨淋巴结活检1枚阳性、组织学分级Ⅰ级的早期乳腺癌患者建议免行ALND,术后积极接受辅助治疗。

     

    Abstract: Objective To investigate the predictive factors of further axillary lymph node dissection in patients with sentinel lymph node biopsy (SLNB)-positive breast cancer. Methods Clinical data about patients with breast cancer received SLNB in Chinese PLA General Hospital from January 2007 to November 2016 were retrospectively collected to investigate the predictive factors of avoiding further axillary lymph node dissection in SLNB-positive breast cancer patients. Results Of the 196 SLNB-positive patients, 121 (61.7%) patients had negative axillary lymph nodes' results and 75 had positive. In univariate analysis, there were significantly statistical differences between two categories in age (P=0.062), histological grade (P=0.009), number of positive sentinel lymph nodes (P=0.002) and pathological T staging (P=0.078). Multivariate analysis revealed that the number of positive sentinel lymph nodes (≥ 3 vs 1, OR=4.159, P=0.003) and histological grade of breast cancer (Ⅲ vs Ⅰ, OR=2.287, P=0.011) provided further indications for ALND. Conclusion Patients with one positive SLN or SBR gradeⅠ are recommended to be exempt from ALND and receive adjuvant therapy after surgery.

     

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