1、2 枚SLN 阳性乳腺癌患者的NSLN 转移预测

Prediction of non-sentinel lymph node metastasis in breast cancer patients with 1 and 2 positive sentinel lymph nodes

摘要:

目的 分析1、2 枚前哨淋巴结（SLN）阳性乳腺癌患者的临床、病理特征与非前哨淋巴结（NSLN） 转移的关系，验证纪念斯隆凯特琳癌症中心（MSKCC）NSLN 转移预测模型的临床应用价值。方法 选取 2010 年4 月—2017 年10 月于吉林大学白求恩第一医院连续行前哨淋巴结活检证实的1、2 枚SLN 阳性，并 进一步行腋窝淋巴结清扫术的乳腺癌患者294 例。对符合纳入标准的患者临床病理资料进行单因素及多因素 分析，探索其与NSLN 转移的关系。利用MSKCC 模型计算每个患者NSLN 转移的预测值，通过受试者工作 曲线及曲线下面积（AUC）评估其在患者中的应用价值。结果 294 例患者中86 例存在NSLN 转移。脉管 癌栓是否阳性、阳性SLN 数/ 总SLN 数比值比较，差异有统计学意义（P <0.05）。MSKCC 预测模型对研究 人群NSLN 转移预测的AUC 为0.643。结论 SLN 转移率高或存在脉管癌栓的1、2 枚SLN 阳性的患者容易 出现NSLN 转移，MSKCC 模型预测NSLN 转移的准确性不佳。

Abstract:

Objective To investigate the correlations of clinical and pathological characteristics with nonsentinel lymph node (NSLN) metastasis in breast cancer patients with 1 and 2 positive sentinel lymph nodes (SLN), and validate the application value of the NSLN metastasis predictive model of Memorial Sloan-Kettering Cancer Center (MSKCC) in this patients population. Methods Using the BLOU DataBase of breast surgery department in the First Bethune Hospital of Jilin University, the information of 294 patients who accepted sentinel lymph node biopsy and diagnosed with 1 and 2 SLN metastasis between April 2010 and October 2017 was retrospectively analyzed. Correlations of NSLN metastasis with patients’ clinical and pathological data were analyzed by Chi-square test and logistic regression analysis. The predictive value of MSKCC nomogram was evaluated by the area under the receiver operating characteristic curve (AUC). Results NSLN metastasis was found in 86 of the 294 patients. The correlations of NSLN metastasis with lymphovascular invasion and SLN positive number/total SLN number were statistically significant (P < 0.05). The AUC value of the MSKCC predictive model for NSLN metastasis in this study population was 0.643. Conclusions 1 and 2 SLN positive patients with high SLN metastasis rate or with lymphovascular invasion are more likely to have NSLN metastasis. The accuracy of MSKCC nomogram in predicting NSLN metastasis is low for breast cancer patients in the First Bethune Hospital of Jilin University.