| Objective: To explore the risk factors affecting axillary lymph node metastasis in breast cancer,and to provide reference for the development of more reasonable individualized treatment plans and assessment of prognosis.Materials and Methods: By collecting surgical data from January 1st to December 31 st,2015 in the Second Affiliated Hospital of Dalian Medical University,there were 342 cases of patients with complete postoperative pathology and axillary lymph node grouping.Axillary lymph node metastasis was confirmed in 146 patients with postoperative pathology.A total of 8483 axillary lymph nodes were detected,averaging 24.8 per patient.There were 4627 I groups,2381 II groups,1334 III groups,and 141 Rotters.A total of 2035 lymph node metastases were confirmed by pathology,including 1,241 in Group I,582 in Group II,158 in Group III,and 54 in Rotter Group.Ages range from 24-74 years,with a median age of 50 years.There were 182 cases of left breast cancer and 160 cases of right breast cancer.There were 144 cases in the upper quadrant,46 in the lower quadrant,89 in the upper quadrant,57 in the lower quadrant,and 6 in the ominous.According to the tumor size,there were 48 cases in T1 stage,154 cases in T2 stage,122 cases in T3 group,16 cases in T4 stage,and 2 ominous cases.According to pathological types,there were 266 invasive ductal carcinomas,28 infiltrating lobular carcinomas,11 infiltrating ductal carcinomas and 11 lobular carcinomas,9 non-specific invasive carcinomas,6 invasive papillary carcinomas,and 5 mucinous carcinomas.There were 4 cases of hard cancer,4 cases of invasive tubal carcinoma,4 cases of Paget disease,3 cases of micro-invasive carcinoma,and 2 cases of medullary carcinoma.Histological grade: There were 126 patients in grade 1,147 in grade 2,and 89 in grade 3.In 342 patients,the axillary lymph node metastases at T1,T2,T3,and T4 were 27.08%,34.42%,57.38%,and 62.50%,respectively,showing that there was a positive correlation between the axillary lymph node metastasis rate and tumor size,with statistical difference(P <0.05),tumor size is an independent factor affecting axillary lymph node metastasis.The categorical data were analyzed using the ?2 test.The positive influencing factors were selected and the logistic regression model was used for data processing.The P value was calculated and if P<0.05,it was considered statistically significant.Result:1.In 342 patients,the number of axillary lymph nodes was 8,483.There were 4627 in group I,2381 in group II,1334 in group III,and 141 in Rotter group.A total of 2035 lymph node metastases were confirmed by pathology.The total lymph node metastasis was 23.99%,including 1241 in group I,582 in group II,158 in group III,and 54 in Rotter group.The degree of lymph node metastasis in each group was 26.28%,24.44%,11.84%,and 38.30%.The degree of lymph node metastasis in group I,II and III gradually decreased with statistical significance(P<0.05).2.In 342 breast cancer patients,146 patients developed axillary lymph node metastasis,with a total metastatic rate of 42.69%.The group I lymph node metastasis was 141 cases,the metastasis rate was 41.23%;group II lymph node metastasis was 102 cases,the metastasis rate was 29.82%;group III lymph node metastasis was 46 cases,the metastasis rate was 13.45%.Axillary lymph node metastasis of breast cancer basically follows the classical I?II?III lymph node metastasis pattern,and it shows a trend of gradually decreasing.There is a statistically significant difference between groups(P<0.05).The rate of jump transfer is 1.46%.3.In 342 patients,the axillary lymph node metastases at T1,T2,T3,and T4 were 27.08%,34.42%,57.38%,and 62.50%,respectively.The axillary lymph node metastasis rate was positively correlated with the tumor volume,with statistical significance(P<0.05),tumor size was an independent factor affecting axillary lymph node metastasis.4.Among 342 patients,the rates of axillary lymph node metastasis were 54.86%,45.65%,30.34%,and 33.33% respectively in the superior,inferior,medial,and inferior quadrants.The metastasis rate of tumor sites and axillary lymph nodes was statistically different(P<0.05).The rate of lymph node metastasis in the outer quadrant was higher than that in the inner quadrant,and there was no significant difference in lymph node metastasis between the upper and lower quadrants(P> 0.05).There was no statistical difference between the outer quadrant and the lower quadrant(P> 0.05).5.Of the 342 breast cancer patients,266 were invasive ductal carcinomas,76 were other pathological types,and infiltrating ductal carcinomas accounted for most of the 77.78%.The rate of axillary lymph node metastasis was significantly higher in infiltrating ductal carcinoma than in other pathological types(P<0.05).6.In 342 breast cancer patients,the rate of axillary lymph node metastasis in vascular tumor emboli and avascular thrombi was 69.51% and 34.50%,respectively.The rate of axillary lymph node metastasis in patients with vascular tumor embolism was higher than that in patients without vascular cancer embolus(P<0.05).Vascular carcinoma thrombus is an independent influencing factor of axillary lymph node metastasis.7.Age,histological grade,ER,PR,Her-2 and axillary lymph node metastasis were not statistically different,ie,there was no correlation(P> 0.05).8.The rate of axillary lymph node metastasis was different among breast cancer patients with different molecular classifications(P<0.05).The rate of axillary lymph node metastasis was 62.79% and 60.87% for Luminal B(Her-2 positive)and basal-1ike(basal-1ike),respectively.The rate of axillary lymph node metastasis was 56.52% for ERBB2+ and Herminal B(Her-2 negative)Axillary lymph node metastasis rate was 37.80%,Luminal type A axillary lymph node metastasis rate was 27.78%.The rate of axillary lymph node metastasis was higher in Luminal B(Her-2 positive)than in Luminal B(Her-2 negative).There was no difference in the rate of axillary lymph node metastasis between Luminal B(Her-2 positive)and ERBB2+(P> 0.05).There was no difference in the rate of axillary lymph node metastasis between ERBB2+ and basal-1ike(P> 0.05).Conclusion:1.Most of the breast axillary lymph node metastases follow the classical step-by-step transfer pattern,and a few of them are transferred by the skip transfer method.2.The larger the tumor is,the more likely it is to have lymph node metastasis.The tumor in the outer quadrant and invasive ductal carcinoma are prone to axillary lymph node metastasis.The size of the tumor and the presence of vascular tumor embolus were independent factors in the occurrence of axillary lymph node metastasis.No correlation between age,histological grade,ER,PR,Her-2,and axillary lymph node metastasis;3.Luminal type B(Her-2 positive)and basal(basal-1ike)type had higher rates of axillary lymph node metastasis.Axillary lymph node metastasis rate of Luminal B(Her-2 positive)is higher than Luminal B(Her-2 negative). |
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