| The American Society of Clinical Oncology(ASCO)guidelines have proposed that 1-2 sentinel lymph node(SLN)positive breast cancer patients who meet the inclusion criteria of ACOSOG-Z0011 trial: no neoadjuvant therapy,cT1-2N0,breast conserving surgery,postoperative total breast radiation and systemic treatment can be exempted from axillary lymph node dissection(ALND).However,whether 1-2 SLN-positive patients that do not completely meet the inclusion criteria of ACOSOG-Z0011 trial can safely be exempted from ALND is still a research hot spot.The average rate of breast cancer patients receiving breast conserving surgery in China is 20%.Therefore,the ASCO guideline has some limitations in China.The non-sentinel lymph node(NSLN)metastasis prediction model of Memorial Sloan Kettering Cancer Center(MSKCC)has been widely verified by foreign scholars and applied in clinical work,while the prediction effect is not consistent between centers in Asian patients.On the one hand,this study explored the risk factors for predicting NSLN metastasis in patients with 1-2 positive SLN;on the other hand,it verified the application value of MSKCC model in patients in our center.Objective:To investigate the correlation between clinical or pathological characteristics and non-sentinel lymph nodes(NSLN)metastases in 1-2 sentinel lymph nodes(SLN)positive breast cancer patients,and validate the MSKCC nomogram to predict the NSLN metastasis in this patients population.Methods:We used the BLOU DataBase of breast surgery department in the First Hospital of JiLin University,and retrospectively analyzed the 294 patients information who accepted sentinel lymph node biopsy(SLNB)and diagnosed with 1-2 SLN metastasis between 4/2010 and 10/2017.Inclusion criteria included: clinical stage t1-2,negative axillary lymph nodes confirmed by imaging and physical examination;Breast cancer was diagnosed by preoperative core needle biopsy,resection biopsy or intraoperative frozen section biopsy;No neoadjuvant chemotherapy or neoadjuvant endocrine therapy;SLNB was successful and 1-2 positive SLNS were confirmed pathologically;Immediate ALND or complete ALND after surgery;Breast surgery includes total mastectomy and breast conserving surgery.Correlation between NSLN metastasis and patient's clinical or pathological information was analyzed by chi-squar test and logistic regression.The predictive value of MSKCC nomogram was evaluated by the Area Under the Receiver Operating Characteristic Curve(AUC).Results:Among 294 patients with 1-2 SLN positive,86(29.3%,86/294)had NSLN metastasis,while 208(70.7%,208/294)had no NSLN metastasis.There were 1SLN metastasis in 74 patients and 2 SLN metastasis in 220 patients.Among them,238 cases of SLN had macrometastasis,51 cases of SLN were micrometastasis,and 5 cases of SLN were isolated tumor cell metastasis.Total mastectomy was performed in 80.3%(236/294)patients,and breast conserving surgery was performed in only 20.9%(58/294)patients.The result of both univariate and multivariate analysis showed that the correlation between NSLN metastasis and lymphovascular invasion(LVI)and SLN positive number/total SLN number was statistically significant(P< 0.05).The AUC value predicted by the MSKCC prediction model for NSLN metastasis in this study population was0.643.Conclusion:Positive SLN number/total SLN number equal to 1 and LVI positive is an important indicator to predict the NSLN metastasis in breast cancer patients with1-2 SLN positive samples.When both factors exist,the probability of NSLN metastasis increases to 60%.The MSKCC model has low value in predicting NSLN in breast cancer patients with 1-2 SLN-positive samples in our center.More reliable tools for predicting NSLN metastasis are needed to avoid unnecessary ALND in breast cancer patients with 1-2 sentinel noden-positive and do not fully meet the inclusion criteria of ACOSOG Z0011 trial. |
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