Correlation Between Different Molecular Staging Of Breast Cancer And Axillary Lymph Node Metastasis

Objective: Breast cancer is the most common malignant tumor in women,and its morbidity and mortality have shown a trend of increasing year by year.With the popularization of mammography screening and precise individual treatment,its overall survival rate and prognosis have been significantly improved.The physiopathology and prognosis of breast cancer with different molecular staging have shown significant differences.In this paper,we will explore the differences of axillary lymph node metastasis among different molecular staging of breast cancer and the risk factors affecting axillary lymph node metastasis through statistical analysis,in order to provide more basis for the diagnosis and treatment of breast cancer.Methods: In this study,we collected clinical case data of breast cancer patients from2012 to 2022 in the glandular vascular surgery department of the Affiliated Hospital of Yan’an University.315 study subjects were screened strictly according to the nadir criteria and classified into four types: Luminal A,Luminal B,HER-2 overexpressing and triple negative according to the 2022 edition of CSCO guidelines.The relationship between these types and axillary lymph node metastasis was investigated and the risk factors affecting axillary lymph node metastasis were analyzed.The data were analyzed and processed using SPSS 27.0 software,and P < 0.05 indicated that the differences were statistically significant.The t-test and chi-square test were used to analyze the differences between groups for measurement data and count data,respectively(Fisher’s exact probability method was used when necessary).Multifactorial analysis was performed using multiple logistic regression,and the prognostic value of risk factors was evaluated according to the ROC curve.Results:(1)In terms of clinical parameters,no statistically significant differences were found between axillary lymph node metastasis in terms of age and menstrual status,while high BMI,central region and lateral quadrant showed higher rates of lymph node metastasis(P < 0.05).(2)In terms of pathological features,significant differences were found between axillary lymph node status and tumor size,histological(SBR)grading and vascular infiltration(P < 0.05),while There was no statistically significant difference in pathological types.(3)In terms of molecular markers,there was no statistically significant difference in axillary lymph node metastasis rate among breast cancer patients in the comparison of different ER,PR and Ki-67 levels(all P values were greater than 0.05),while statistically significant differences were shown in HER-2 overexpression(56.5%)and HER-2 negative(42.3%)groups.(4)In terms of molecular staging,the lymph node metastasis rate of breast cancer patients differed among staging(P=0.025).(5)Multiple logistic regression analysis showed that the rate of axillary lymph node metastasis was associated with tumor size,SBR grading,choroidal infiltration and tumor location,and the differences were statistically significant(all P values were less than 0.05).(6)The results of ROC curve analysis showed that the tumor size and SBR The area under the curve(AUC)of tumor size and SBR grading was 0.576(P < 0.05),and the AUC of the combined factor of both was 0.610,suggesting that the combination of tumor size and SBR grading has some accuracy in predicting axillary lymph node metastasis(P = 0.001).(7)Patients with Luminal B and HER-2 overexpression breast cancer had higher lymph node metastasis rates,which were 52.6% and 56.5;while triple-negative breast cancer showed a lower rate of lymph node metastasis(36.4%).(8)In both groups of patients with T1 and T2 stages,there was a significant difference in the rate of axillary lymph node metastasis among different molecular subtypes of breast cancer(P < 0.05).(9)Among different molecular subtypes,the Luminal A-Luminal B group(P = 0.047),Luminal A-HER-2 overexpression group(P=0.015)and HER-2 overexpression-triple negative group(P=0.026)had statistically significant differences between groups.Conclusions:(1)Tumor size,tumor location,SBR grading and choroidal infiltration are independent risk factors for axillary lymph node metastasis.(2)The combination of tumor size and SBR grading has some accuracy in predicting axillary lymph node metastasis.(3)Higher lymph node metastasis rates exist in Luminal B and HER-2overexpression breast cancer,while triple negative breast cancer has lower axillary lymph node metastasis rates.(4)In the Luminal A-Luminal B,Luminal A-HER-2 overexpression and HER-2 overexpression-triple negative groups,there was a difference in the rate of axillary lymph node metastasis between their groups.