Risk Factors Of Non-sentinel Lymph Nodes Involvement In Sentinel Node Positive Patients And Validation Of MSKCC Nomogram In Breast Cancer Population

Objective Clinical data of sentinel lymph node(SLN)-positive breast cancer patients were retrospectively studied to investigate the risk factors associated with non-sentinel lymph node metastasis in SLN-positive breast cancer patients in the region,using the US Memorial Sloan-Kate Cancer Center(MSKCC).The non-sentinel lymph node(NSLN)metastasis prediction model was used to evaluate breast cancer patients in this region and the clinical application value of this model in local breast cancer patients was analyzed based on the evaluation results.Methods A total of 1356 cases of breast cancer diagnosed from the Third Clinical Medical College of Xinjiang Medical University from January2015 to May 2016 were collected.After confirmation of the intraoperative and postoperative HE-stained specimens by the Department of Pathology in our hospital,SLN was identified.Axillary NSLN transfer situation.The clinical data of SLNB patients with SLN metastasis and SLN metastasis were statistically analyzed.The risk factors of NSLN metastasis in this group of patients were statistically analyzed;the risk of NSLN metastasis in each patient was evaluated according to the MSKCC prediction model.Therelevant clinical data were evaluated using the receiver operating curve(ROC curve)and area under the curve(AUC),and the results were used to verify whether the model was applicable to the population.Results A total of 715 breast cancer patients received SLNB,of whom 240 were SLN-positive and ALND-treated.This group of patients was included in the study.Data were analyzed using unconditional binary Logistic univariate and multivariate regression methods and the results were obtained: the ratio of the number of positive sentinel lymph nodes(SLN+)to the total sentinel lymph node number(SLN)(OR=0.129,95%,CI:0.065-0.253,P<0.01),Vascularinvasion(OR=0.280,95%CI:0.117-0.670,P=0.004)was statistically significant,and both were independent risk factors for metastasis of NSLN in the axilla.The AUC value of the MSKCC prediction model in this study population was 0.810(95% CI was 0.757-0.864);the AUC value of the Han subgroup was 0.791(95% CI was 0.726-0.856);the Uygur subgroup was 0.871(95%CI was 0.784-0.957).Conclusion SLN+/SLN and vessel invasion in sentinel node-positive breast cancer patients are independent risk factors for metastatic NSLN;MSKCC model has better prediction accuracy for Uygur patients in the study population,and accurate prediction for Han patients in the study population.