Analysis Of Risk Factors For Axillary Recurrence After Sentinel Lymph Node Biopsy For Early Breast Cancer

Objective:About 0.3%-2% of early breast cancer cases treated with sentinel lymph node biopsy(SLNB)underwent axillary recurrence(AR),which had a negative influence on the prognosis.SLNB was introduced by Krag and Giuliano in the mid-1990 s,and large randomized clinical trials had confirmed that for early breast cancer patients with negative sentinel lymph node(SLN),SLNB had replaced ALND as part of standard treatment.However,there was an increasing concern about the effect of SLNB alone over AR risk and how to predict and treat AR.The purpose of this study was to determine the rate and risk factors of AR after SLNB in patients with early breast cancer and to explore the effect of SLNB alone on the prognosis of breast cancer patients.Methods:We conducted a retrospective analysis of 1133 cases of breast cancer from January 2008 to April 2017 in Tianjin Medical University Cancer Hospital.The inclusion criteria were: pathologically confirmed breast cancer,clinically T1-2,clinically negative axillary lymph nodes,all patients received SLNB.To collect and record clinical data of these patients,SPSS24.0 software was used for statistical analysis to analyze the relationship between age,history of breast disease,family history of breast cancer,tumor size,vascular infiltration,number of SLN detected,SLN metastasis,histological grade,pathological type,TNM stage,hormone receptor,molecular subtypes,preoperative neoadjuvant chemotherapy,adjuvant therapy(radiotherapy,chemotherapy)and AR after SLNB.To investigate the incidence of AR and risk factors related to AR in breast cancer patients after SLNB is used only,and to analyze the prognosis of patients.Results:Median follow-up was 34.4 months.AR was observed in 14 cases,AR rate is1.2%.The enrolled patients were divided into axillary recurrent group and non-axillary recurrent group,Chi-square analysis shows that the occurrence of AR was significantly correlated with histological grade(P = 0.025)and PR(P = 0.029)and molecular subtypes(P = 0.040).Survival analysis showed that menopausal status(P = 0.011),tumor size(P =0.015),PR status(P = 0.045)and chemotherapy(P = 0.017)in univariate analysis were the influencing factors for the overall survival time of breast cancer patients after SLBN.Tumor size(P = 0.017),histological grade(P = 0.001),ER(P = 0.003),PR(P = 0.0003),Ki67(P = 0.028)and molecular subtypes(P = 0.0004)were influential factors for disease-free survival of breast cancer patients after SLBN.Multivariate analysis of prognosis showed that age(P = 0.005)was an independent prognostic factor affecting overall survival time in patients with breast cancer after SLNB surgery;PR(P = 0.030)was an independent prognostic factor affecting disease-free survival in patients with breast cancer after SLNB surgery.Conclusion:1.The occurrence of AR in patients with early breast cancer after SLNB surgery was related to a variety of factors.Histological grade,PR and molecular subtypes were significantly correlated with the occurrence of AR in patients with SLNB surgery.2.Univariate analysis of prognosis of all patients with early breast cancer after SLNB surgery show that tumor size,menopausal status,PR status and chemotherapy were the influencing factors for the overall survival time of breast cancer patients after SLBN surgery.Tumer size,histological grade,ER,PR,Ki67 and molecular subtypes were the influencing factors for disease-free survival time of breast cancer patients after SLBN.Multivariate analysis showed that age was an independent prognostic factor affecting overall survival time in patients with breast cancer after SLNB surgery;PR status was an independent prognostic factor affecting disease-free survival in patients with breast cancer after SLNB surgery.