Analysis On The Influencing Factors Of Non-sentinel Lymph Node Metastasis In Breast Cancer Patients With Positive Sentinel Lymph Nodes

OBJECTIVE:To analyze the influencing factors and correlation with inflammatory markers of non-sentinel lymph node（NSLN）metastasis in breast cancer patients with positive lymph node（SLN）,which can provide scientific basis for reducing unnecessary axillary lymph node dissection（ALND）and avoid overtreatment.METHODS:The clinicopathological data of 267 breast cancer patients with SLN metastasis,who underwent sentinel lymph node biopsy（SLNB）and axillary lymph node dissection（ALND）in the breast cancer center of Affiliated Cancer Hospital of Guangxi Medical University from January 1,2014 to December 31,2018 were collected.At the same time,the date of four inflammatory markers including preoperative neutrophil-to-lymphocyte ratio（NLR）,derived neutrophil-to-lymphocyte ratio（d NLR）,platelet-to-lymphocyte ratio（PLR）and lymphocyte-to-monocyte ratio（LMR）were collected.The cases were divided into high and low groups separately according to the medians of NLR,d NLR,PLR and LMR,and the correlation between inflammatory markers and clinicopathological characteristics of breast cancer was analyzed.The clinical,pathological date and inflammatory markers were analyzed by univariate analysis,and then the variables with statistical differences in univariate analysis and clinically significance were analyzed by multivariate Logistic regression analysis to explore the influencing factors of NSLN metastasis.RESULTS:Of the 267 breast cancer patients with SLN metastasis,115 had NSLN metastasis,accounting for 43.1%.The median values of NLR,d NLR,PLR and LMR were 1.86,1.45,141.30 and 5.35,respectively.There were no statistical difference between the levels of NLR,d NLR and LMR and the clinicopathological characteristics（（49）>0.05）,while there were statistical differences in age（（49）=0.002）,menstrual status（（49）=0.012）and family history of malignant tumor（（49）=0.010）between the high PLR group and low PLR group.The median values of NLR,d NLR,PLR and LMR in the NSLN negative group and positive group were 1.89 vs.1.86,1.44 vs.1.46,143.25 vs.139.61 and 5.30vs.5.38,respectively,with no statistical difference（（49）>0.05）.Using univariate analysis,tumor T staging(χ^（17）=4.142,（49）=0.042),lymphovascular invasion(χ^（17）=20.226,（49）<0.001),the numbers of positive SLN(χ^（17）=46.262,（49）<0.001),the numbers of negative SLN(χ^（17）=24.102,（49）<0.001)and the ratio of SLN metastasis(χ^（17）=32.458,（49）<0.001)were associated with NSLN metastasis.Based on the results of binary Logistic regression analysis,the variables that were identified as independent risk factors for NSLN metastasis included tumor T staging（OR=0.488,95%CI:1.137-3.698;（49）=0.017）,lymphovascular invasion（OR=2.066,95%CI:1.164-3.668;（49）=0.013）,the numbers of positive SLN（（49）<0.001）and the ratio of SLN metastasis（（49）=0.034）.Among them,SLN positive numbers=2（OR=2.170,95%CI:1.136-4.145;（49）=0.019）and SLN positive numbers≥3（OR=5.570,95%CI:2.387-12.994;（49）<0.001）had a higher risk than patients with SLN positive number=1.The ratio of SLN metastasis=1（OR=2.870,95%CI:1.135-7.257;（49）=0.026）had a higher risk than patients with the ratio of SLN metastasis<0.5.CONCLUSIONS:Tumor T staging,lymphovascular invasion,the numbers of positive SLN and ratio of SLN metastasis are independent influencing factors for NSLN metastasis in breast cancer patients with a positive SLN.According to the above factors,a clinical predictive model can be established to evaluate the risk of NSLN metastasis,so as to guide the selection of axillary surgery.The four inflammatory markers of NLR,d NLR,PLR and LMR may not be related to NSLN metastasis.