Risk Factors Of Non-sentinel Lymph Node Metastasis And Validation Of MSKCC And Louisville Nomograms In Breast Cancer Patients

Objective:To analyze the risk factors of non-sentinel lymph node(NSLN)metastasis in breast cancer patients with sentinel lymph node(SLN)metastasis,in order to screen out those patients with positive SLN and exempt from axilarry lymph node dissection(ALND),and to evaluate the predictive efficacy of MSKCC and Louisville nomorgrams in the local population.Methods:The clinical and pathological date of 60 breast cancer patients with positive SLN between June 2013 and September 2019 who underwent ALND after sentinel lymph node biopsy(SLNB)at the Nanhai Hosipital Affiliated To Southern Medical University were collected.The relationship between these factors and NSLN jhmetastasis was compared by chi-square test or Fisher exact test.A multivariate Logistic regression analysis was used determine the independent predictors of NSLN metastasis.Visit the MSKCC NSLN metastasis nomogram website to calculate the risk of NSLN metastasis in each patient.The risk of NSLN metastasis in each patient was calculated according to the calculation formula described in the literature related to the Louisville nomogram.The predictive accuracy in local populations was assessed by drawing a receiver-operating characteristic(ROC)curve and calculating the area under the curve(AUC).Results:The chi-square test or Fisher's exact test showed that Ki67(P=0.019),the number of positive SLN(P=0.047),the number of negative SLN(P=010),and the proportion of positive SLN(P=0.043)were associated with NSLN metastases in patients.Multivariate regression analysis showed that the number of SLN(OR=2.820,95%CI:1.009?7.884,P=0.048)was an independent risk factor for NSLN metastasis and the mimber of negative SLN(OR=0.302,95%CI:0.100?0.915 P=0.034)was an independent protective factor for NSLN metastasis.The AUC of the MSKCC nomogram in the sample population was 0.639 and the 95%confidence interval was 0.493?0.786.The AUC of the Louisville nomogram in the study population was 0.657,and the 95%confidence interval was 0.5]5?0.798,The accuracy of the two nomograms was low.Conclusion:l.In breast cancer patients with SLN positivity,Ki67 and SLN metastasis rates were associated with NSLN metastasis,but were not independent influencing factors.The number of positive SLN is an independent risk factor for NSLN metastasis in patients with positive SLN,while the number of negative SLN is an independent protective factor for NSLN metastasis in patients with positive SLN.2.The accuracy of the MSKCC and Louisville nomograms in predicting the sample population in this study is low.These two nomograms should be used carefully to screen the exempted axillary lymph node dissection population.