Analysis of axillary non<b>-</b>sentinel lymph node metastasis and risk factors in breast cancer patients with 1<b>–</b>2 positive sentinel lymph nodes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Manjin ¹ , WU Baochao ¹ ,  WANG Dezhi ¹ , WANG Haiyi ¹ , YUAN Xiaoqing ²

1. Department of Thyroid and Breast Surgery, Tongling People’s Hospital, Tongling, Anhui 244000, P. R. China;
2. Department of Pathology, Tongling People’s Hospital, Tongling, Anhui 244000, P. R. China;

Corresponding author：

WANG Dezhi, Email: wdz0718@qq.com

Keywords：

breast cancer; sentinel lymph node; non-sentinel lymph node metastasis; sentinel lymph node biopsy; axillary lymph node dissection; risk factor

DOI：

10.7507/1007-9424.202305015

Video：

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Objective To investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.

Citation： WANG Manjin, WU Baochao, WANG Dezhi, WANG Haiyi, YUAN Xiaoqing. Analysis of axillary non-sentinel lymph node metastasis and risk factors in breast cancer patients with 1–2 positive sentinel lymph nodes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1087-1092. doi: 10.7507/1007-9424.202305015 Copy

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2.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
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7.	van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol, 2011, 37(4): 290-299.
8.	Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg, 2016, 264(3): 413-420.
9.	Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA, 2017, 318(10): 918-926.
10.	Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
11.	Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
12.	Huang Z, Wu Z, Zou QQ, et al. Risk factors of non-sentinel lymph node metastasis in breast cancer with 1-2 sentinel lymph node macrometastases underwent total mastectomy: a case-control study. World J Surg Oncol, 2023, 21(1): 125.
13.	李凯, 蒋慧, 陈斌. 前哨淋巴结阳性乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析. 皖南医学院学报, 2023, 42(1): 53-56.
14.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版). 中国癌症杂志, 2021, 31(10): 954-1040.
15.	刘磊, 李国政, 张蕾, 等. 1个前哨淋巴结阳性乳腺癌患者的腋窝非前哨淋巴结转移情况及危险因素分析. 中国肿瘤外科杂志, 2022, 14(1): 22-26.
16.	莫文菊, 丁小文, 陈波, 等. 前哨淋巴结阳性2个以下的T1~2乳腺癌患者非前哨淋巴结转移的相关因素. 肿瘤学杂志, 2019, 25(5): 427-431.
17.	Maimaitiaili A, Wu D, Liu Z, et al. Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients. Cancer Biol Med, 2018, 15(3): 282-289.
18.	陈炬莹, 林肖鹰, 蔡双龙. 早期乳腺癌患者非前哨淋巴结转移危险因素分析. 深圳中西医结合杂志, 2022, 32(24): 34-38.
19.	Wang X, Gao Y, Yang X, et al. Omitting ALND is not safe for a cohort of early-stage breast cancer patients with 1-2 SLNs macro-metastases and breast-conserving therapy: A single-center retrospective study. Iran J Public Health, 2020, 49(7): 1262-1268.
20.	王雪, 陈丽璇, 孙娅惠, 等. 前哨淋巴结阳性个数与早期乳腺癌非前哨淋巴结转移的相关性分析. 天津医科大学学报, 2019, 25(4): 337-341.
21.	张琳琳, 朱德淼, 闫恒宇, 等. 前哨淋巴结阳性早期乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析. 中国现代医学杂志, 2021, 31(5): 15-19.
22.	杨红星, 贾国丛, 陈雨婷, 等. 早期乳腺癌前哨淋巴结阳性患者非前哨淋巴结转移危险因素分析. 中华实用诊断与治疗杂志, 2018, 32(5): 445-447.
23.	Meng L, Zheng T, Wang Y, et al. Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes. Sci Rep, 2021, 11(1): 19972.
24.	Kuru B, Sullu Y, Yuruker S, et al. Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases: Presentation of Ondokuz Mayis scoring system. J BUON, 2016, 21(5): 1129-1136.

1. DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin, 2019, 69(6): 438-451.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4. Tonellotto F, Bergmann A, de Souza Abrahão K, et al. Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer. Eur J Breast Health, 2019, 15(2): 76-84.
5. Abdelhamid MI, Bari AA, Farid MI, et al. Evaluation of axillary reverse mapping (ARM) in clinically axillary node negative breast cancer patients-Randomised controlled trial. Int J Surg, 2020, 75: 174-178.
6. Kennard JA, Stephens AJ, Ahmad S, et al. Sentinel lymph nodes (SLN) in endometrial cancer: The relationship between primary tumor histology, SLN metastasis size, and non-sentinel node metastasis. Gynecol Oncol, 2019, 154(1): 53-59.
7. van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol, 2011, 37(4): 290-299.
8. Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg, 2016, 264(3): 413-420.
9. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA, 2017, 318(10): 918-926.
10. Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
11. Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
12. Huang Z, Wu Z, Zou QQ, et al. Risk factors of non-sentinel lymph node metastasis in breast cancer with 1-2 sentinel lymph node macrometastases underwent total mastectomy: a case-control study. World J Surg Oncol, 2023, 21(1): 125.
13. 李凯, 蒋慧, 陈斌. 前哨淋巴结阳性乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析. 皖南医学院学报, 2023, 42(1): 53-56.
14. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版). 中国癌症杂志, 2021, 31(10): 954-1040.
15. 刘磊, 李国政, 张蕾, 等. 1个前哨淋巴结阳性乳腺癌患者的腋窝非前哨淋巴结转移情况及危险因素分析. 中国肿瘤外科杂志, 2022, 14(1): 22-26.
16. 莫文菊, 丁小文, 陈波, 等. 前哨淋巴结阳性2个以下的T1~2乳腺癌患者非前哨淋巴结转移的相关因素. 肿瘤学杂志, 2019, 25(5): 427-431.
17. Maimaitiaili A, Wu D, Liu Z, et al. Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients. Cancer Biol Med, 2018, 15(3): 282-289.
18. 陈炬莹, 林肖鹰, 蔡双龙. 早期乳腺癌患者非前哨淋巴结转移危险因素分析. 深圳中西医结合杂志, 2022, 32(24): 34-38.
19. Wang X, Gao Y, Yang X, et al. Omitting ALND is not safe for a cohort of early-stage breast cancer patients with 1-2 SLNs macro-metastases and breast-conserving therapy: A single-center retrospective study. Iran J Public Health, 2020, 49(7): 1262-1268.
20. 王雪, 陈丽璇, 孙娅惠, 等. 前哨淋巴结阳性个数与早期乳腺癌非前哨淋巴结转移的相关性分析. 天津医科大学学报, 2019, 25(4): 337-341.
21. 张琳琳, 朱德淼, 闫恒宇, 等. 前哨淋巴结阳性早期乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析. 中国现代医学杂志, 2021, 31(5): 15-19.
22. 杨红星, 贾国丛, 陈雨婷, 等. 早期乳腺癌前哨淋巴结阳性患者非前哨淋巴结转移危险因素分析. 中华实用诊断与治疗杂志, 2018, 32(5): 445-447.
23. Meng L, Zheng T, Wang Y, et al. Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes. Sci Rep, 2021, 11(1): 19972.
24. Kuru B, Sullu Y, Yuruker S, et al. Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases: Presentation of Ondokuz Mayis scoring system. J BUON, 2016, 21(5): 1129-1136.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of axillary non-sentinel lymph node metastasis and risk factors in breast cancer patients with 1–2 positive sentinel lymph nodes

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