| [Backgroud]:Breast cancer is a common female malignant tumor. In recent years, the age of breast cancer has advanced than before, we can find many young people with breast cancer in the clinic. Axillary lymph node involvement is the most significant and durable prognostic factor for breast cancer. Axillary lymph node dissection in breast cancer patients has become a routine procedure. The focus of recent studies has been the identification of patients unlikely to benefit from axillary lymph node dissection because the risk of nodal metastases is extremely low. Sentinel lymph node biopsy has been widely accepted as an appropriate initial alternative to routine staging axillary lymph node dissection in early breast cancer.But because of the economic and technical reason,this technology can't be widely used. If we can identify predictive factors and developed models to select patients with nonaxillary lymph node involvement, the people will avoid the potential morbidities such as lymphedema, seroma, wound infection, paresthesia or brachial plexus injury.[Material and Method]:From January 1999 to January 2009 ,we identified 423 female breast cancer patients who has intact medical records in China- Japan Union Hospital of Jilin University. Deal all data with X2 test and Bayes discriminatory analysis by SPSS11.0 software.[Result]:The results show that T-size, tumor location is significantly associated with an increase in the odds of Axillary lymph node metastasis.Larger tumors are more commonly associated with involved axillary lymph nodes. T1,T2,T3,T4 group the lymph node metastasis rates are 35.0%,61.5%,2.4%,76.5%,the statistically difference significant(P<0.05).Tumor location is also closely related to lymph node metastasis, multi-center>external >central >internal,the result of statistical comparison is P<0.05.Diagnosis mathematical model about Breast cancer as follow:Y1(without lymph node metastasis)= -12.670+9.055 X1+5.290 X2-0.490 X3+0.370 X4+1.585 X5-1.047 X6+3.374 X7+ 3.259X8+0.0407 X9+0.0258 X10; Y2(with lymph node metastasis)=-13.799+8.647 X1+6.159 X2-0.785 X3+0.799 X4+1.581 X5-1.777 X6+3.141X7+ 3.293X8+ 0.0895 X9+0.0125 X10.The result of self-verification is: Correct rate is 79.4%,The result of cross validation is64.7%.[Discussion]:In recent years, the age of breast cancer has advanced than before, we can find many young people with breast cancer in the clinic.Sariego etal reported that the age factor had nothing to do with axillary lymph node metastasis. Fang Cai said that the incidence rate of axillary lymph node metastasis in the youth group is significantly higher than in the older group. The study of this group shows that the youth group was prone to lymph node metastasis, the rate was 61.5%, being higher than the older group (51.8%), but there is no significant statistical difference. Whether it can achieve statistical significance with the increase in samples'number, depends on the further study.Asker's study of the axillary lymph node metastases on 134 breast cancer patients showed that the diameter of tumour≤2cm, the axillary lymph node metastasis rate was 14% (7 / 50), the diameter of tumour was between 2cm and 5cm, it was 54% (29/54), and the diameter of tumour> 5.0cm, it was 87% (26/30),P <0.01 . Axillary lymph node status and tumor size have long been considered to be the most significant prognostic factors for breast cancer patients. Our results shows that the greater the primary tumor, the higher the axillary lymph node metastasis rate. T1, T2, T3, T4 group of lymph node metastasis rate is 35.0%, 61.5%, 72.4%, 76.5%(P <0.05) . T-size is significantly associated with an increase in the odds of ALNM. In the group of T1 period, the axillary lymph node metastasis rate is significantly lower than other groups, but still reach 35.0 %. That is said even smaller tumor can not be ruled out the possibility of axillary lymph node metastasis. So that it should not be only based on tumor size to decide whether or not lymph node dissection be enforced.The predictive role of sex hormone receptor status in previous investigations is controversial.Boon's studies report no value for both ER and PR status. Vial points that lack of PR was associated with a reduction in the risk of axillary lymph nodes metastases.In our series show the level of ER,PR have no relationship with the axillary lymph nodes metastases (P>0.05).C-erbB-2 is one kind of oncogene,its over-expression can lead to the occurrence of tumor.We find that the positive expression rate of C-erbB-2 is 59.8%.The expression level have no relationship with the lymph node metastasis(P>0.05).LiLuo and WenJChen thought that the incidence of axillary lymph node metastasis: external>central>internal.However,Reger and Lei Xu think that the tumor location has no association with axillary lymph node metastasis. In our report tumor locates in multi-center metastasisi rate is the highest 57.4%(27/47),external and central is on the second,rate is 56.9%(156/274),52.3%(23/44)respectively,While the tumor in the inter metastasis rate is the lowest 31.0%(18/58),Significant difference among the groups significantly(P<0.05),this conform with LiLuo and WenJChen 's reports.With improved mammographic screening, breast cancers are being diagnosed earlier, thereby decreasing the incidence of lymph node involvement. Although proven as a safe and reliable procedure, sentinel lymph node biopsy still has potential morbidities such as lymphedema, seroma, wound infection, paresthesia or brachial plexus injury that could be clinically relevant for the patients.Moreover, survival benefits from axillary surgery are still debated.so identified predictive factors and developed models to select patients with nonaxillary lymph node involvement is necessary.We set up a diagnosis mathematical model about breast cancer by Bayes discriminatory analysis.In this model 79.4% of original grouped cases correctly classified,64.7% of cross-validated grouped cases correctly classified.In addition our report showes that menopause and mulifocality of tumor have no association with axillary lymph node metastasis in breast cancer.ALL in all, Axillary lymph node involvement is the most significant and durable prognostic factor for breast cancer. T-size, tumor location is significantly associated with an increase in the odds of Axillary lymph node metastases . Diagnosis mathematical model plays a role in axillary lymph node metastasis diagnosis. |
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