Pathological Factors Predict Non-sentinel Lymph Node Metastasis In Early Breast Cancer

BackgroundThe status of axillary lymph node has an important guiding significance for the staging,prognosis and treatment of breast cancer.Sentinel lymph node biopsy has been widely accepted both at home and abroad for assessing the status of axillary lymph nodes in patients with early stage breast cancer.Sentinel lymph node biopsy negative to avoid axillary lymph node dissection,thereby reducing the forearm and armpit sensory abnormalities,persistent lymph node edema and axillary clearance caused by limb weakness and other complications,while the positive sentinel lymph node biopsy is still advocated axillary lymph node dissection.However,relevant studies have shown that a significant portion of sentinel lymph node-positive patients only have part of the sentinel lymph node metastases,and no metastases have been found in the non-sentinel lymph nodes of the axillary post-swept lymph nodes.So I think it is necessary to study the relevant clinicopathologic factors affecting non-sentinel lymph node metastasis in the axilla,and to explore the rule of all negative SLN positive states in non-sentinel lymph nodes,so that this part of SLN-positive patients can also avoid unnecessary axillary lymph node dissection to improve the patient's quality of life.ObjectiveTo analyze the relevant clinicopathological data of sentinel lymph node biopsy positive early-stage breast cancer patients and explore the risk factors of NSLN metastasis,making it possible for some patients with low risk of metastasis to avoid axillary lymph node dissection and improve the patient's quality of life.MethodsFrom January 2014 to August 2016,102 early breast cancer patients with sentinel lymph node(SLN)metastasis who underwent auxiliary lymph node dissection at the First Affiliated Hospital of Anhui Medical University were retrospectively assessed.ResultsThe NSLN was positive in 42 patients and the other 60 patients were negative.Univariate analysis of clinical and pathological features:The tumor size(?~2=9.362,P=0.002),number of metastatic SLNs(?~2=7.513,P=0.023)and number of negative SLNs(?~2=8.963,P=0.003)were significantly associated with NSLN metastasis in univariate analysis.Univariate analysis of the number of positive sentinel lymph node dummy variables:By using dummy variable,the risk of tumor metastasis in patients with 2positive SLNs and more than 2 positive SLNs was respectively greater than patients with 1 positive SLN(OR=2.625,3.656,all P<0.05).Multivariate analysis of non-sentinel lymph node metastasis:The tumor size(P=0.020,OR=2.122)and the number of metastatic SLNs(P=0.010,OR=1.660)remained independently increasing risk for NSLN metastasis in multivariate analysis.However,the number of negative SLNs was a protective factor(P=0.004,OR=0.733).ConclusionsFor patients with low risk of metastasis(primary tumor sizes smaller than 2cm,the number of metastatic SLNs less than 2 and negative SLNs greater than 1),Combined systemic postoperative treatment(chemotherapy,radiotherapy,endocrine therapy,molecular targeted therapy,etc.)may be considered to avoid axillary dissection.