中华临床医师杂志(电子版) 2017年2月,11卷3期

临床论著

不同分子分型的乳腺癌前哨淋巴结转移与临床病理特征的关系研究

应可明1 燕归如1 孙民昌1 龙芳2 陈峥1 阚炳华1

723000 陕西省,汉中市中心医院肿瘤外科1,科教科2
应可明,Email: kemingying0912@163.com

摘要:  目的 研究腋窝前哨淋巴结(SLN)在不同分子分型乳腺癌的转移情况及其与临床病理特征之间的相关性。方法 采用全乳切除术或保乳术+前哨淋巴结活检术(SLNB)对187例乳腺癌患者行手术治疗,将患者分为SLN阳性和阴性两组,应用免疫组化法检测肿瘤组织中ER、PR、HER-2以及Ki-67的表达并对所有乳腺癌患者行分子分型,运用χ2检验分析乳腺癌SLN转移与临床病理因素的关系,采用Logistic模型对SLN转移的相关因素进行多因素回归分析。结果 187例乳腺癌患者中,SLN阳性组94例,阴性组93例。单因素分析显示,年龄(χ2=6.033,P=0.014)、脉管癌栓侵犯(χ2=14.121,P<0.001)、HER-2阳性(χ2=3.865,P=0.049)、分子分型(χ2=11.237,P=0.021)、肿瘤T分期(χ2=9.807,P=0.020)与乳腺癌SLN转移有关;多因素分析表明,脉管癌栓侵犯(OR=6.447,95% CI 1.78~23.311,P=0.004)、HER-2阳性(OR=2.541,95% CI 1.178~5.482,P=0.017)、分子分型(OR=0.767,95% CI 0.601~0.978,P=0.033)、肿瘤T分期(OR=0.607,95% CI 0.430~0.857,P=0.005)为影响乳腺癌SLN转移的主要危险因素。结论 不同分子分型的乳腺癌患者的SLN转移有其不同的特点,对于除T4d期以外临床腋窝淋巴结阴性的浸润性乳腺癌患者,脉管癌栓侵犯、HER-2基因过度表达与乳腺癌SLN转移关系密切;T1期的Luminal A型乳腺癌SLN转移率最低,该型乳腺癌患者是SLNB的最佳适应证;T4期的Luminal B2型乳腺癌SLN最易发生转移,对于该型乳腺癌患者行SLNB需保持谨慎态度,应综合考虑患者病情及手术可行性等多方面因素后慎重决定。

关键词: 乳腺肿瘤; 分子分型; 前哨淋巴结活检; 前哨淋巴结转移

Relation research of sentinel lymph node metastasis and clinical pathologic characteristics in different molecular classification of breast cancer

Ying Keming1, Yan Guiru1, Sun Minchang1, Long Fang2, Chen Zheng1, Kan Binghua1.

1Department of Oncological Surgery, 2Department of Science and Education, Hanzhong Center Hospital, Hanzhong 723000, China
Ying Keming, Email: kemingying0912@163.com

Abstract:  Objective To study the correlation between sentinel lymph node (SLN) metastasis of axilla and clinicopathological features in different molecular classification of breast cancer. Methods 187 cases of breast cancer patients which were divided into positive SLN group and negative group were treated with total mastectomy or confirmed breast augmentation plus sentinel lymph node biopsy (SLNB). We had applied immunohistochemical method to detect the expression of ER, PR, HER-2 and Ki-67 in tumor tissue and used the chi-square test to analyze the relationship between metastasis of SLN and clinical pathological factors and adopted the Logistic model to conduct multivariate regression analysis for relevant factors of metastasis of SLN in breast cancer. Results There were 187 cases of breast cancer patients who were splited into positive SLN group (n=94) and negative group (n=93). Univariate analysis showed that age (χ2=6.033, P=0.014), lymphovascular invasion (χ2=14.121, P<0.001), positive HER-2 gene (χ2=3.865, P=0.049), molecular classification (χ2=11.237, P=0.021), T stage of tumor (χ2=9.807, P=0.020) were associated with metastasis of SLN (P<0.05); Multivariate analysis revealed that only lymphovascular invasion (OR=6.447, 95% CI 1.78-23.311, P=0.004), positive HER-2 gene (OR=2.541, 95% CI 1.178-5.482, P=0.017), molecular classification (OR=0.767, 95% CI 0.601-0.978, P=0.033), T stage of tumor (OR=0.607, 95% CI 0.430-0.857, P=0.005) which were the main risk factors had affected metastasis of SLN in breast cancer (P<0.05). Conclusions The metastasis of SLN of different molecular classification of breast cancer has its different characteristics. Besides T4d phase of invasive breast cancer patients whose clinical axillary lymph node are negative, lymphovascular invasion, excessive gene expression of HER-2 are closely associated with metastasis of SLN in breast cancer; Luminal A breast cancer in T1 which are the best indication of SLNB are the lowest metastasis rate of SLN. Luminal B2 tumors in T4 for which we should remain cautious attitude and comprehensively consider various factors such as patient's condition and feasibility of operation before careful decision.

Keywords:Breast neoplasms; Molecular typing; Sentinel lymph node biopsy; Metastasis of SLN

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(编辑:梁雷 收稿日期:2016-08-29)