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目的探讨T1~2期乳腺癌患者临床与病理因素与腋窝淋巴结转移的关系,指导前哨淋巴结活检术(SLNB)的应用,以避免腋窝清扫术(ALND)后并发症的发生。方法收集接受手术且经病理确诊的T1~2期乳腺癌病例,对其临床病理资料进行回顾性统计分析。通过单因素分析和多因素Logistic回归分析寻找乳腺癌发生腋窝淋巴结转移的影响因素。结果共2108例患者入组,其中1021例患者发生淋巴结转移(48.4%)。单因素分析显示年龄、肿瘤大小、病理类型、组织学分级、脉管瘤栓、ER、PR、Ki-67指数以及分子分型等因素与淋巴结转移有关(P﹤0.05);而HER-2是否过表达与淋巴结转移无关。多因素Logistic回归分析显示,患者的腋窝淋巴结转移的独立影响因素为肿瘤大小、病理类型、组织学分级、脉管瘤栓、ER表达状况(P﹤0.05);而年龄也可能是腋窝淋巴结有无转移的独立影响因素(P=0.053)。结论肿瘤越大、分化越差、伴脉管瘤栓、ER阳性表达以及病理类型为浸润性小叶癌的T1~2期乳腺癌患者的淋巴结转移风险更高,而年龄≤50岁也可能增加了腋窝淋巴结转移的风险。T1~2期乳腺癌患者是否直接行ALND应持谨慎的态度。
Objective To investigate the relationship between clinical and pathological factors and axillary lymph node metastasis in patients with T1 ~ 2 breast cancer, and to guide the application of sentinel lymph node biopsy (SLNB) in order to avoid the complications after axillary dissection (ALND). Methods Twenty-two cases of breast cancer who underwent surgery and were confirmed by pathology were collected. The clinical and pathological data were retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to find out the influencing factors of axillary lymph node metastasis in breast cancer. Results A total of 2108 patients were enrolled, of whom 1021 patients developed lymph node metastasis (48.4%). Univariate analysis showed that age, tumor size, pathological type, histological grade, tumor thrombus, ER, PR, Ki-67 index and molecular type were related to lymph node metastasis (P <0.05) Overexpression has nothing to do with lymph node metastasis. Multivariate logistic regression analysis showed that the independent influencing factors of axillary lymph node metastasis were the tumor size, pathological type, histological grade, angioma suppository and ER expression (P <0.05), and the age was also the presence of axillary lymph nodes Independent factors of metastasis (P = 0.053). Conclusion The larger the tumor, the poorer the differentiation is, the higher the risk of lymph node metastasis is with T1-stage 2 breast cancer with vascular tumor thrombus, ER positive expression and infiltrative lobular carcinoma pathology, while the age ≤50 years may also increase Risk of axillary lymph node metastases. T1 ~ 2 breast cancer patients should be directly ALND should be cautious attitude.