中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
5期
346-349
,共4页
王荣%陈洁%田春祥%范雪娇%傅月荷%汪静%李宏江%王晓东%吕青
王榮%陳潔%田春祥%範雪嬌%傅月荷%汪靜%李宏江%王曉東%呂青
왕영%진길%전춘상%범설교%부월하%왕정%리굉강%왕효동%려청
乳腺肿瘤%淋巴转移%因素分析,统计学
乳腺腫瘤%淋巴轉移%因素分析,統計學
유선종류%림파전이%인소분석,통계학
Breast neoplasms%Lymphatic metastasis%Factor analysis,statistical
目的 探讨乳腺癌腋窝Ⅲ水平淋巴结转移的高危因素.方法 回顾性分析2001年8月至2011年12月收治的746例乳腺癌根治术或改良根治术行Ⅰ～Ⅲ水平淋巴结清扫患者的临床资料,患者均为女性,年龄33 ～ 80岁,中位年龄46岁.选取11个可能与乳腺癌Ⅲ水平淋巴结转移相关性较大的因素,分析不同情况下Ⅲ水平淋巴结转移的高危因素.结果 腋窝Ⅰ～Ⅱ水平淋巴结移数目(OR =4.541,95％CI:3.569 ～5.776)、肿瘤位置(OR=1.437,95％ CI:1.029～2.007)、淋巴结外浸润(OR =3.809,95％ CI:1.683 ～8.618)、雌激素受体表达阴性(OR =0.740,95％ CI:0.569 ～0.964)是Ⅲ水平淋巴结转移的高危因素.进一步分层分析表明:T3期以上的肿瘤位于外侧时更容易发生腋窝Ⅲ水平淋巴结转移(x2外侧比内侧=4.458,P=0.035;x2外侧比乳晕区=7.090,P=0.008),ER表达阴性时随着肿瘤分期的增高更容易发生Ⅲ水平淋巴结转移(x2T3比T1=6.133,P=0.013;x2T3比T2=5.664,P=0.017).结论 对于术前乳腺肿瘤穿刺活检证实ER表达阴性的T3期及以上的肿瘤、术中探查疑腋窝Ⅰ～Ⅱ水平淋巴结较多转移或疑伴有淋巴结外组织浸润时,宜积极行腋窝Ⅲ水平淋巴结清扫.
目的 探討乳腺癌腋窩Ⅲ水平淋巴結轉移的高危因素.方法 迴顧性分析2001年8月至2011年12月收治的746例乳腺癌根治術或改良根治術行Ⅰ～Ⅲ水平淋巴結清掃患者的臨床資料,患者均為女性,年齡33 ～ 80歲,中位年齡46歲.選取11箇可能與乳腺癌Ⅲ水平淋巴結轉移相關性較大的因素,分析不同情況下Ⅲ水平淋巴結轉移的高危因素.結果 腋窩Ⅰ～Ⅱ水平淋巴結移數目(OR =4.541,95％CI:3.569 ～5.776)、腫瘤位置(OR=1.437,95％ CI:1.029～2.007)、淋巴結外浸潤(OR =3.809,95％ CI:1.683 ～8.618)、雌激素受體錶達陰性(OR =0.740,95％ CI:0.569 ～0.964)是Ⅲ水平淋巴結轉移的高危因素.進一步分層分析錶明:T3期以上的腫瘤位于外側時更容易髮生腋窩Ⅲ水平淋巴結轉移(x2外側比內側=4.458,P=0.035;x2外側比乳暈區=7.090,P=0.008),ER錶達陰性時隨著腫瘤分期的增高更容易髮生Ⅲ水平淋巴結轉移(x2T3比T1=6.133,P=0.013;x2T3比T2=5.664,P=0.017).結論 對于術前乳腺腫瘤穿刺活檢證實ER錶達陰性的T3期及以上的腫瘤、術中探查疑腋窩Ⅰ～Ⅱ水平淋巴結較多轉移或疑伴有淋巴結外組織浸潤時,宜積極行腋窩Ⅲ水平淋巴結清掃.
목적 탐토유선암액와Ⅲ수평림파결전이적고위인소.방법 회고성분석2001년8월지2011년12월수치적746례유선암근치술혹개량근치술행Ⅰ～Ⅲ수평림파결청소환자적림상자료,환자균위녀성,년령33 ～ 80세,중위년령46세.선취11개가능여유선암Ⅲ수평림파결전이상관성교대적인소,분석불동정황하Ⅲ수평림파결전이적고위인소.결과 액와Ⅰ～Ⅱ수평림파결이수목(OR =4.541,95％CI:3.569 ～5.776)、종류위치(OR=1.437,95％ CI:1.029～2.007)、림파결외침윤(OR =3.809,95％ CI:1.683 ～8.618)、자격소수체표체음성(OR =0.740,95％ CI:0.569 ～0.964)시Ⅲ수평림파결전이적고위인소.진일보분층분석표명:T3기이상적종류위우외측시경용역발생액와Ⅲ수평림파결전이(x2외측비내측=4.458,P=0.035;x2외측비유훈구=7.090,P=0.008),ER표체음성시수착종류분기적증고경용역발생Ⅲ수평림파결전이(x2T3비T1=6.133,P=0.013;x2T3비T2=5.664,P=0.017).결론 대우술전유선종류천자활검증실ER표체음성적T3기급이상적종류、술중탐사의액와Ⅰ～Ⅱ수평림파결교다전이혹의반유림파결외조직침윤시,의적겁행액와Ⅲ수평림파결청소.
Objective To study the high risk factors of the third level of lymphatic metastasis in breast cancer patients to guide clinical practice.Methods The clinical data of 746 breast cancer patients (all female,aged from 33 to 80 years with a median of 46 years) received radical or modified mastectomy between 2001 and 2011 was analyzed retrospectively.Eleven individual variables were selected to investigate high risk factors of the third level of lymphatic metastasis in different conditions.Results Axillary nodes metastasis status (OR =4.541,95％ CI:3.569-5.776),tumor site (OR =1.437,95％ CI:1.029-2.007),external nodes involved (OR =3.809,95％ CI:1.683-8.618) and estrogen receptor (OR =0.740,95％CI:0.569-0.964) were high risk factors of the third level of lymphatic metastasis.Further analysis found that it is prone to happen a metastasis,especially when the tumor with a size over 5 cm and located at the lateral quadrant.Negative estrogen receptor was a risk factor of the third level lymphatic metastasis along with the tumor stage.Conclusion For preoperative tumor biopsy shows Negative estrogen receptor of tumor stage T3 and over stage T3 when considering suspicious lymph node metastasis or external tissues metastasis introperatively should take in account into third level axillary lymph node dissection actively.
