| Objective: To explore the relationship between different factors and the prognosis of axillary lymph nodes in patients with breast cancer after neoadjuvant therapy,and to find the related factors of axillary lymph nodes in patients with neoadjuvant therapy from positive descending stage to negative.To provide a basis for some patients with neoadjuvant therapy to be exempted from axillary lymph node dissection.Methods:To retrospectively study 80 cases of all neoadjuvant breast cancer patients admitted to our hospital from August 2018 to November 2019.These patients were positive for axillary lymph nodes before neoadjuvant therapy and received neoadjuvant therapy containing taxanes and anthracyclines.The treatment cycle was 4 to 8 courses,and surgery was performed after neoadjuvant therapy.It includes sentinel lymph node biopsy(SLNB)and axillary lymph node dissection(ALND).Patients with pathologically negative axillary lymph nodes after ALND were divided into group A,and patients with positive axillary lymph nodes after ALND were divided into group B.statistical methods were used to compare the differences between group A and group B in age,clinical stage,immunohistochemical index,neoadjuvant therapy regimen,neoadjuvant therapy cycle,operation mode and so on,P < 0.05.There were significant differences between group A and group B in terms of age,clinical stage,immunohistochemical index,neoadjuvant therapy cycle and operation mode.The related factors of axillary lymphatic outcome after neoadjuvant therapy were obtained,and the changes of false negative rate of SLNB were compared according to the relevant factors.Results: 1.Among the 80 patients who received neoadjuvant therapy,34 cases were postoperative axillary lymph node negative(group A),the postoperative axillary lymph node negative rate was 42.5%,and 46 cases were postoperative axillary lymph node positive(group B).The positive rate of postoperative axillary lymph nodes was 57.5%.2.The age of patients in group A was 50.6±8.8 years,and the same age of patients in group B was 51.6±8.3 years.The difference between the two groups was not statistically significant(P>0.05).In group A and group B,the clinical stages were high index of PR and low index of PR,positive index of HER-2 and negative index of HER-2,high index of Ki-67 and low index of Ki-67 in group An and group B.the distribution of patients who underwent breast conserving surgery or modified radical mastectomy after neoadjuvant therapy with TAC or AC-T or AC-TH,neoadjuvant therapy cycle was less than 6 courses or at least 6 courses.There was no significant difference(P > 0.05).The distribution of low index of ER or high index of ER and low index of Ki-67 / high index of Ki-67 in group A and group B was significantly different(P < 0.05).Among them,the difference in axillary lymph node outcome corresponding to different states of KI-67 in the low ER expression group and the axillary lymph node outcome corresponding to different states of ER in the Ki-67 high expression group were significant(P<0.05);3.The axillary negative rate of patients with low index of ER was 60.0%(18/30),which was higher than that of patients with high index of ER(32.0%)(16/50).The axillary negative rate of patients with high index of Ki-67 was51.9%(28/54),which was higher than that of patients with low index of Ki-67(23.1%).The analysis of binary Logistic regression including ER,PR,HER-2 and Ki-67 showed that the OR value for low ER index was 2.461,95% CI was 0.917 to 6.604,P<0.05;the OR value of Ki-67 high index was 2.757,95% CI was 0.331 to 4.764,P<0.05.It suggests that low index of ER and high index of Ki-67 are predictors of negative axillary lymph nodes.4.The detection rate of SLNB in 80 patients was 93.75%(75/80),and the false negative rate was 15.21%(7/46).After stratification by low index of ER or high index of Ki-67,the false negative rate of SLNB in 28 patients with low index of ER was 8.30%(1/11),and the false negative rate of SLNB in 52 patients with high index of Ki-67 was 7.60%(2/24).Conclusion:1.For breast cancer patients with axillary lymph node metastasis before neoadjuvant therapy,ER and Ki-67 are predictors of axillary lymph node prognosis after neoadjuvant therapy.Patients with low index of ER or high index of Ki-67 are more likely to turn negative after standard neoadjuvant therapy.2.Sentinel lymph node biopsy is a reliable method to determine the status of axillary lymph nodes after neoadjuvant treatment in breast cancer patients with metastatic axillary lymph nodes before neoadjuvant treatment with low ER expression or high Ki-67 expression.If SLNB meets the following conditions:(1)use metal markers to mark positive axillary lymph nodes before neoadjuvant therapy;(2)visualize sentinel lymph nodes with dual tracers;(3)detect more than three sentinel lymph nodes and other conditions,and the result of SLNB is negative,you should carefully consider whether it can be exempt from ALND. |
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