2019 年第 4 期 第 14 卷

乳腺导管原位癌伴微小浸润腋窝前哨淋巴结转移的危险因素分析

Risk factors of axillary sentinel lymph node metastasis in breast ductal carcinoma in situ with microinvasion

作者：张明帅刘思吟蒋威华李涌涛王晓文欧江华甫拉提·吾瓦力汉

英文作者：

单位：830011乌鲁木齐，新疆医科大学附属肿瘤医院乳腺外科二病区

英文单位：

关键词：乳腺肿瘤；导管原位癌伴微小浸润；前哨淋巴结

英文关键词：

• 摘要：

• 【摘要】目的    分析乳腺导管原位癌伴微小浸润（DCIS-MI）患者的临床病理特点及腋窝前哨淋巴结转移的危险因素。方法    选取2004年1月至2016年6月新疆医科大学附属肿瘤医院乳腺外科收治并经病理确诊的女性乳腺DCIS-MI患者共79 例，收集患者临床病理资料进行回顾性分析，采用Logistic回归方法分析DCIS-MI腋窝前哨淋巴结转移的危险因素。结果    79例患者均顺利完成腋窝前哨淋巴结活检，其中3例（3.8%）患者出现腋窝前哨淋巴结转移，其中2例（2.5%）为宏转移，1例（1.3%）为微转移。淋巴结转移数目1例为2枚，其余2例均为1枚。3例前哨淋巴结出现转移的患者随后均行腋窝淋巴结清扫，非前哨淋巴结均未发现转移。单因素分析结果显示，年龄（P＜0.001）、肿瘤大小（P=0.005）、组织学分级（P＜0.001）及Ki-67表达（P=0.026）均与DCIS-MI患者腋窝前哨淋巴结转移相关。多因素Logistic回归分析结果显示，肿瘤大小＞3 cm（比值比=14.645,95%置信区间：4.485～47.821，P＜0.001）、高组织学分级（比值比=10.023,95%置信区间：4.242～23.668，P＜0.001）是预测DCIS-MI患者腋窝前哨淋巴结转移的独立危险因素。结论    DCIS-MI发生腋窝淋巴结转移的风险较低，肿瘤直径较大、组织学分级较差是DCIS-MI腋窝前哨淋巴结转移的独立危险因素。

• 【Abstract】Objective    To analyze the clinicopathological characteristics of breast ductal carcinoma in situ with microinvasion(DCIS-MI) and the risk factors of axillary sentinel lymph node metastasis. Methods    Clinical and pathological data of 79 DCIS-MI patients who underwent surgery from January 2004 to June 2016 in Tumor Hospital Affiliated to Xinjiang Medical University were retrospectively studied. Risk factors of axillary sentinel lymph node metastasis were analyzed. Results    All patients underwent axillary sentinel lymph node biopsy; 3 cases(3.8%) had lymphatic metastasis, including 2 cases(2.5%) of macrometastasis and 1 case(1.3%) of micrometastasis. There was 1 case of double node metastases and 2 cases of single node metastasis. The 3 cases had axillary lymph node dissection and no non-sentinel lymph node metastasis was found. Univariate analysis showed that age（P＜0.001）, tumor size（P=0.005）, histological grade（P＜0.001） and Ki-67 expression（P=0.026） were related with axillary sentinel lymph node metastasis. Multivariate logistic regression showed that tumor size＞3 cm（odds ratio=14.645, 95% confidence interval： 4.485-47.821， P＜0.001） and high histological grade（odds ratio=10.023, 95% confidence interval： 4.242-23.668， P＜0.001） were independent risk factors of axillary sentinel lymph node metastasis. Conclusions    Patients with DCIS-MI have low risk of axillary lymph node metastasis. Large tumor size and poor histological grade are independent risk factors of axillary sentinel lymph node metastasis in DCIS-MI patients.