CAJ | 학술논문

目的探讨前哨淋巴结(SLN)转移状况对非前哨淋巴结(nSLN)转移的预测价值；同时分析SLN 1/n转移患者避免腋窝淋巴结清除(ALND)或是缩小手术范围的可行性.方法回顾山东省肿瘤医院1998年11月至2011年12月自开展前哨淋巴结活检(SLNB)以来的2265例乳腺癌患者的临床病理资料,其中接受ALND的乳腺癌患者1228例,根据SLN转移状况分成SLN(-)、SLN(1/n)、SLN (1/1)、SLN(n/N)和SLN(n/n)(n≥2、N≥3和N＞n)5组,比较分析各状态间nSLN转移的特点.结果 SLN(-)组nSLN转移率为11.8％(73/618),SLN(1/n)组为25.2％ (65/258),SLN(1/1)组为49.6％(67/135),SLN(n/N)组为48.4％(60/124),SLN (n/n)组为65.6％(61/93),各组间nSLN转移情况差异均有统计学意义(均P＜0.01)；两两比较发现,SLN(-)组患者与SLN(1/n)、(1/1)、(n/N)、(n/n)组患者nSLN转移情况比较差异均有统计学意义(均P＜0.01)；SLN 1/n转移患者与SLN(1/1)、(n/N)、(n/n)组患者nSLN转移情况之间的比较差异均有统计学意义(均P＜0.01)；而SLN(1/1)、(n/N)、(n/n)组之间差异并无统计学意义(P=0.842、0.017、0.042,X2分割).SLN 1/n转移的患者腋窝Ⅱ、Ⅲ水平淋巴结转移的情况与SLN无转移的患者差异无统计学意义(P=0.012、0.570,X2分割).结论 SLN转移状况与nSLN转移有相关性；SLN 1/n转移的患者nSLN转移概率低于SLN 1/1、n/N、n/n转移的患者,对于SLN 1/n转移的部分患者仅行低位腋淋巴结清除术可能是安全的,但是不能仅通过SLN 1/n转移这一指标免行ALND,需要综合考虑其他临床病理学因素的影响.
목적 탐토전초림파결(SLN)전이상황대비전초림파결(nSLN)전이적예측개치；동시분석SLN 1/n전이환자피면액와림파결청제(ALND)혹시축소수술범위적가행성.방법 회고산동성종류의원1998년11월지2011년12월자개전전초림파결활검(SLNB)이래적2265례유선암환자적림상병리자료,기중접수ALND적유선암환자1228례,근거SLN전이상황분성SLN(-)、SLN(1/n)、SLN (1/1)、SLN(n/N)화SLN(n/n)(n≥2、N≥3화N＞n)5조,비교분석각상태간nSLN전이적특점.결과 SLN(-)조nSLN전이솔위11.8％(73/618),SLN(1/n)조위25.2％ (65/258),SLN(1/1)조위49.6％(67/135),SLN(n/N)조위48.4％(60/124),SLN (n/n)조위65.6％(61/93),각조간nSLN전이정황차이균유통계학의의(균P＜0.01)；량량비교발현,SLN(-)조환자여SLN(1/n)、(1/1)、(n/N)、(n/n)조환자nSLN전이정황비교차이균유통계학의의(균P＜0.01)；SLN 1/n전이환자여SLN(1/1)、(n/N)、(n/n)조환자nSLN전이정황지간적비교차이균유통계학의의(균P＜0.01)；이SLN(1/1)、(n/N)、(n/n)조지간차이병무통계학의의(P=0.842、0.017、0.042,X2분할).SLN 1/n전이적환자액와Ⅱ、Ⅲ수평림파결전이적정황여SLN무전이적환자차이무통계학의의(P=0.012、0.570,X2분할).결론 SLN전이상황여nSLN전이유상관성；SLN 1/n전이적환자nSLN전이개솔저우SLN 1/1、n/N、n/n전이적환자,대우SLN 1/n전이적부분환자부행저위액림파결청제술가능시안전적,단시불능부통과SLN 1/n전이저일지표면행ALND,수요종합고필기타림상병이학인소적영향.
Objective To explore the value of sentinel lymph nodes (SLN) metastasis status in predicting the presence of residual disease in non-sentinel lymph nodes (nSLN) and the feasibility of avoiding or reducing the scope of axillary lymph node dissection (ALND) for patients with single positive SLN.Methods A retrospective study was conducted for 2265 patients with invasive breast carcinomas undergoing sentinel lymph nodes biopsy (SLNB) at Shandong Cancer Hospital between November 1999 and December2011.And 1228 patients with axillary dissection were screened and divided into 5 groups of (-),(1/n),(1/1),(n/N),(n/n) (n≥2,N≥3,N ＞ n) according to the status of SLN metastasis.Results The nSLN metastasis rate of SLN(-),(1/n),(1/1),(n/N) and (n/n) groups was 11.8％ (73/618),25.2％ (65/258),49.6％ (67/135),48.4％ (60/124) and 65.6％ (61/93)respectively.A comparison of SLN(-),(1/n),(1/1),(n/N),and (n/n) groups of nSLN metastasis showed a significant difference (P =0.000).The differences of nSLN metastasis between SLN (-) and other groups (including 1/n,1/1,n/N,n/n group) were significant (P =0.000).This difference was also significant between SLN (1/n) and other positive groups (include 1/1,n/N,n/n group) (P =0.000),but not significant between SLN(1/1),(n/N) and (n/n) groups (P =0.842,0.017,0.042 respectively,Chi-square segmentation).No significant difference existed between axillary lymph node metastasis on Level Ⅱ and Ⅲ of SLN 1/n group and SLN (-) group (P =0.012,0.570,x2 segmentation).Conclusions The status of SLN metastasis is one of influencing factors for the nSLN metastasis of patients with invasive breast cancer.The possibility of non-sentinel lymph node involvement for patients with single SLN metastasis was smaller than that of other SLN-positive patients.It is safe for some SLN 1/n patients to undergo low lymph node dissection.But ALND is not avoided for patients with single positive SLN (SLN 1/n n ≥ 2).Their clinicopathological variables should be also considered.