【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。更多还原

【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.更多还原