Explore The Influencing Factors Of Non-sentinel Lymph Node Metastasis And Establish A Model

background:The incidence of breast cancer is increasing year by year and tends to be younger.At present,the treatment of breast cancer is based on surgery,combined with chemotherapy,targeted,endocrine,and traditional Chinese medicine treatments.In recent years,despite the continuous improvement of surgical methods,axillary lymph node dissection is still a conventional method for treating axillary lymph nodes.Axillary lymph node dissection can cause complications such as edema,sensory and motor dysfunction of the affected upper limb.Breast cancer patients with negative sentinel lymph node biopsy do not need axillary lymph node dissection,while patients with positive biopsy require axillary lymph node dissection.Studies have shown that among breast cancer patients with positive sentinel lymph node biopsy,about 40% of patients have no axillary non-sentinel lymph node metastasis,indicating that further axillary lymph node dissection has not benefited these patients.In addition,studies have shown that there is no statistically significant difference in the 10-year disease-free survival rate of patients in the sentinel lymph node biopsy group compared with the axillary lymph node dissection group.Therefore,how to predict the metastasis of non-sentinel lymph nodes and screen out patients who do not need axillary lymph node dissection can reduce operation time,reduce postoperative complications,and reduce medical costs for patients,which has clinical significance,economic and social benefits.Many researchers have studied the influencing factors of non-sentinel lymph node metastasis,but the factors obtained are complex and inconsistent.Researchers at home and abroad have also established models for predicting non-sentinel lymph node metastasis,which have achieved certain clinical significance.However,in actual clinical applications,the findings are not universally applicable to every patient,and the operation is relatively complicated.Objective:This study explored the risk factors of non-sentinel lymph node metastasis in female breast cancer patients with positive sentinel lymph node biopsy,and constructed a predictive model for axillary lymph node dissection,in order to predict more simply and accurately,and provide a reference for axillary lymph node dissection.Materials and Method:A collection of 346 female breast cancer patients with positive sentinel lymph nodes who were admitted to Zhengzhou University People’s Hospital from January2015 to June 2020 were collected.All patients underwent axillary lymph node dissection during the operation.The patients were divided into two groups according to the status of non-sentinel lymph nodes after operation,namely the non-sentinel lymph node negative group and the non-sentinel lymph node positive group.The comparison between the two groups was by t test,the count data was compared by X2 test,and the risk factors were analyzed by multivariate Logistic regression.Finally,RStudio 3.4 software was used to establish a predictive model of non-sentinel lymph node metastasis,to produce a nomogram,depict the ROC curve,and calculate the areas under the curves(AUC).And apply Bootstrap method to internally verify the established prediction model,and draw a calibration curve.Result:1.This study collected a total of 346 female breast cancer patients with positive sentinel lymph nodes.The results showed that there were 96 non-sentinel lymph node negative patients,accounting for 27.7%,and 250 non-sentinel lymph node positive patients,accounting for 72.3 %.2.Patients in the non-sentinel lymph node positive group have a tumor with a maximum diameter of> 2～5 cm(53.6%),vascular tumor thrombus(66.0%),the number of positive sentinel lymph nodes> 2(14.8%),and HER-2 positive(85.6%)The rate was higher than that of the non-sentinel lymph node negative group(38.5%,32.3%,6.2%,66.7%)(P<0.05).Tumor maximum diameter> 2～5 cm(OR=1.910,95%CI: 1.126-3.281,P=0.017),vascular tumor thrombus(OR=4.306,95%CI:2.560-7.396,P=0.001),sentinel lymph node The number of positive> 2(OR=2.933,95%CI: 1.207-8.356,P=0.027),HER-2 positive(OR=3.445,95%CI: 1.874-6.398,P=0.001)is independent of non-sentinel lymph node metastasis Risk factors.3.A model for predicting non-sentinel lymph node metastasis was established using the four factors of maximum tumor diameter,vascular tumor thrombus,positive number of sentinel lymph nodes,and HER-2,and a nomogram was drawn,and the AUC value was 0.752 from the ROC curve(95%CI: 0.696-0.808).Then the Bootstrap method is used to internally verify the established prediction model,and the calibration prediction curve fits well with the ideal curve.Conclusion:1.Non-sentinel lymph node metastasis and maximum tumor diameter,vascular tumor thrombus,positive number of sentinel lymph nodes,and HER-2 are statistically significant.2.The largest tumor diameter,vascular tumor thrombus,the number of positive sentinel lymph nodes,and HER-2 are independent risk factors for non-sentinel lymph node metastasis.3.The established model is effective in predicting non-sentinel lymph node metastasis,and it is easy to use,and has certain clinical reference value.