| Objective: To investigate the correlation between clinical features,molecular subtypes and prognosis of small lesions of invasive ductal carcinoma of small breast,multiple axillary lymph node metastasis.Methods: The clinicopathological data of 226 cases of small lesions with multiple axillary lymph node to breast invasive ductal carcinoma in our hospital were retrospectively analyzed,the Pearson chi-square test was used to analyze and compare the differences in different groups of clinicopathological factors in different groups of axillary lymph nodes and different prognosis,the Kaplan-Meier method and Log-rank test were used to analyze the median tumor-free survival time in different states of prognostic related factors,and the COX proportional hazard model was used for multivariate survival analysis.Results: 1.Comparative analysis of clinical features between different degrees of metastasis of axillary lymph nodes,including comparative analysis between different groups such as age,menstruation,tumor diameter,histological grade,ER,PR,Her-2,molecular subtype,prognosis,etc.The results showed that:(1)there were no significant differences in lymph node metastasis status among different groups such as age,menstruation,tumor diameter,and histological grade;(2)The degree of axillary lymph node metastasis was compared between different groups such as ER,PR and Her-2,and 61.2% of the 9 PR-positive groups ≤ PR negative group,41.8% of the PR negative group,and 6.1% of the 20PR-positive groups and 14.7% of the PR-negative group ≥ lymph node metastasis,the difference was statistically significant(=6.437,P=0.040).There was no significant difference between ER and Her-2 groups;(3)Compared with the degree of lymph node metastasis between molecular subtypes,Luminal B type accounted for 60.0% ≤ lymph node metastasis,while other molecular subtypes accounted for 39.3%,46.4%,38.4%,53.7%,three-positive type and triple-negative type accounted for 53.6% and 50.0% in10-19 lymph node metastasis,respectively,and Luminal B type accounted for 23.3%,the difference was statistically significant(=16.315,P=0.038).(4)The degree of lymph node metastasis was compared between the prognostic groups,and the tumor-free survival group accounted for 63.3% ≤ 9 lymph node metastasis,while the recurrent metastasis group accounted for 34.4%,the tumor-free survival group accounted for 7.8%in 20 ≥ lymph node metastasis,and the recurrent metastasis group accounted for 12.8.%,the difference was statistically significant(=18.186,P=0.000).2.The results showed that:(1)there was no statistical difference in prognosis status between different groups such as age,menstruation,and histological grade(P>0.05),and the larger the tumor diameter,the higher the distant metastasis rate,and the difference was statistically significant(=14.553,P=0.006);(2)The tumor-free survival rate of ER and PR positive group was 54.3% and 67.3%,respectively,and the distant metastasis rate of ER and PR negative group was 53.1% and 46.9%,respectively,and the difference was statistically significant(ER: =11.078,P=0.004;PR: =20.367,P=0.000);(3)According to the molecular subtype,the tumor-free survival of Luminal A and Luminal B was higher than that of the other three groups,with 16 cases(57.1%)and 20 cases(66.7%),respectively,12 cases(42.9%)and 23 cases(42.6%)of three-positive and Her-2 overexpression distant metastases,and 54 cases(62.8%)of distant metastases of triple-negative type,the difference was statistically significant(=25.746,P=0.001).(4)There were 19 cases(10.1%)of distant lymph node metastasis in the radiotherapy group and 11 cases(28.9%)of distant lymph node metastasis in the non-radiotherapy group,with a statistically significant difference(=10.592,P=0.005).There was no significant difference in prognosis between chemotherapy and endocrine therapy(P>0.05).3.Survival analysis of prognostic influencing factors showed that the median tumor-free survival time of ER and PR negative group was significantly lower than that of the positive group(P<0.05),the median tumor-free survival time of Luminal type B was longer than that of other types of breast cancer(P<0.05),and the median tumor-free survival time decreased significantly with the increase of positive lymph nodes(P <0.05).COX multivariate analysis showed that the number of lymph node metastasis and endocrine therapy were the prognostic factors of small lesions with multiple axillary lymph nodes to breast invasive ductal carcinoma(P=0.000,P=0.019),and the molecular subtype was not the influencing factor of recurrence and metastasis of such breast cancer,but the results showed that Luminal type B had a better prognosis(P=0.025).Conclusion: Small lesions with multiple axillary lymph node to breast invasive ductal carcinoma are mostly triple-negative,and the number of lymph node metastases is an independent factor affecting its prognosis. |
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