The Influencing Factors Of Sentinel Lymph Node Metastasis In Early Breast Cancer And The Axillary Operation Choice

Objective:Surgery is the main treatment for breast cancer.Patients with early breast cancer have the chance to undergo sentinel lymph node biopsy(SLNB).And axillary lymph node dissection can be avoided when patients have no sentinel lymph node metastasis.The incidence of complications such as upper limb edema and sensory dysfunction can be significantly reduced,so the postoperative quality of life can be improved.However,about 30%of patients have positive lymph nodes after SLNB,and most of these patients continue to undergo axillary lymph node dissection.This not only wastes medical resources,but also increases the incidence of postoperative complications and brings more pain to patients.Therefore,the physician needs to accurately assess the patient's axillary condition before surgery in order to develop an individualized treatment plan.By exploring the risk factors of sentinel lymph node metastasis,this study established a prediction model of axillary lymph node status to predict the risk of sentinel lymph node metastasis and guide clinicians to choose an appropriate axillary operation for patients.Methods:The clinicopathological data of patients with early-stage breast cancer from July 2015 to December 2019 for SLNB in the breast surgery department of Qilu Hospital were analyzed retrospectively.167 patients with positive sentinel lymph nodes were involved in experimental group,and 264 patients with no sentinel lymph node metastasis were the controls.Clinicopathologic indicators associated with sentinel metastasis were analyzed by univariate and multivariate analyses.Sentinel lymph node metastasis model was established by Logistic regression.Receiver-Operator characteristic(ROC)curves of the single factor and the model were established to evaluate the predictive efficacy of the model by area under the curve.The maximum Youden index determines the cutoff point to predict sentinel node metastasis.For patients with sentinel lymph node metastasis,the non-sentinel lymph node status was used as the dependent variable to get the characteristics of patients with non-sentinel lymph node metastasis.Results:Age,body mass index,disease duration,BI-RADS classification,T stage,vascular cancer embolus,progesterone receptor and Ki-67 were showed statistically significant differences between the two groups by single factor analysis(p<0.05).Multivariate Logistic analysis showed that body mass index,disease duration,T stage,vascular cancer embolus and progesterone receptor were independent risk factors for sentinel lymph node metastasis(p<0.05).Based on the results of Logistic regression,a prediction model for SLN metastasis was established.The prediction equation was logit(P)=0.604xX1+0.643×X2+0.559xX3+0.956xX4+0.577×X5-2.161.The area under the ROC curve of SLN state evaluated by the model was 0.660(p<0.001).The cut-off point was P=0.3941;When P?0.3941,the risk of SLN metastasis is high;When P<0.3941,the risk of SLN metastasis is low.Further analysis for the non-sentinel lymph node metastasis status of 165 patients with positive sentinel lymph node concluded that the non-sentinel lymph node metastasis status was related to the number of positive sentinel lymph nodes.Conclusion:Age,body mass index,disease duration,BI-RADS classification,T staging,vascular cancer embolus,progesterone receptor and Ki-67 may affect sentinel lymph node metastasis.Body mass index,disease duration,T stage,vascular cancer embolus and progesterone receptor are independent risk factors for sentinel node metastasis.Sentinel lymph node status prediction model based on risk factors can assist clinical diagnosis.Sentinel lymph node biopsy should be performed cautiously in patients with high risk of sentinel lymph node metastasis.Patients with positive sentinel lymph nodes are required to continue axillary lymph node dissection based on the number of positive lymph nodes and subsequent treatment options.