«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

24卷

期数:

2018年05期

页码:

437-441

栏目:

临床医学

出版日期:

2018-09-20

文章信息/Info

Title:

Correlation analysis between molecular subtype and non-sentinel lymph node metastasis in breast cancer patietns with positive sentinel lymph nodes

作者:

王娜娜; 王 雪; 陈丽璇; 张 斌

天津医科大学肿瘤医院乳腺肿瘤一科，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究中心，乳腺癌防治教育部重点实验室，天津300060

Author(s):

WANG Na-na;  WANG Xue;  CHEN Li-xuan;  ZHANG Bin

First Department of Breast Surgery, Cancer Institute and Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin； Tianjin’s Clinical Research Center for Cancer； Tianjin 300060, China

关键词:

乳腺癌; 分子分型; 前哨淋巴结; 非前哨淋巴结转移

Keywords:

breast cancer;  molecular subtype;  sentinel lymph node;  non-sentinel lymph node metastasis

分类号:

R737.9

DOI:

-

文献标志码:

A

摘要:

目的：分析前哨淋巴结(SLN)阳性乳腺癌患者分子分型与非前哨淋巴结转移（NSLN）的相关性。方法：回顾性分析前哨淋巴结阳性且行腋窝淋巴结清扫术的274例浸润性导管癌患者的临床病理资料，对可能影响NSLN状态的变量进行单因素及多因素Logistic回归分析。结果：274例前哨淋巴结阳性患者中，NSLN转移92例（33.6%）。单因素分析结果显示，肿瘤大小（P=0.013）、脉管浸润（P =0.031）、SLN转移灶大小（P=0.002）、SLN（+）/SLN比率（P<0.001）、分子分型（P<0.001）与NSLN转移相关。多因素分析结果显示，肿瘤大小（OR=1.452；95% CI：1.020-2.068；P=0.039）、SLN微转移（OR=0.140；95% CI：0.030-0.663；P=0.013）、SLN（+）/SLN比率（OR=3.533；95%CI：1.834-6.806；P <0.001）以及分子分型是NSLN转移的独立预测因素。以Luminal A作为参考，Luminal B（OR=3.994，95% CI：1.961-8.131；P<0.001）和HER2过表达型（OR=3.252；95% CI:1.057-10.004；P=0.040）发生NSLN转移的风险显著增加，而三阴性乳腺癌发生NSLN转移风险并未明显增加（OR=1.560；95%CI：0.658-3.698；P =0.313)。结论：乳腺癌分子分型是前哨淋巴结阳性乳腺癌NSLN转移的独立预测因素，Luminal B和HER2过表达型更易出现NSLN转移。

Abstract:

Objective: To analyze whether molecular subtype is associated with non-sentinel lymph nodes (NSLN) metastasis and explore the risk factors for NSLN metastasis in patients with a positive SLN. Methods: The clinicopathologic data of 274 breast cancer patients with sentinel lymph node metastasis who underwent axillary lymph node dissection were collected. Independent risks for non-sentinel lymph node metastasis were assessed by univariate and multivariate analyses. Results：NSLN metastasis was found in 92(33.6%) of 274 patients with a positive SLN. Based on the results of the univariate analysis, the variables that were significantly associated with the incidence of NSLN metastasis in a SLN positive patient included tumor size (P=0.013), the size of SLN metastasis (P =0.002), lymphovascular invasion (P =0.031), the ratio of positive SLN(P<0.001) and molecular subtype(P<0.001). Using multivariate analysis, tumor size(OR = 1.452； 95% CI: 1.020-2.068； P = 0.039), the size of SLN metastasis(OR = 0.140； 95% CI: 0.030-0.663；P = 0.013), the ratio of positive SLN（OR=3.533 95%CI: 1.834-6.806；P<0.001） and molecular subtype were identified as independent predictors for non-SLN metastasis. Patients with Luminal B (OR=3.994; 95% CI: 1.961-8.131; P<0.001) and HER2 overexpression subtypes (OR=3.252; 95% CI:1.057-10.004； P=0.040) had a higher risk of NSLN metastasis than patients with the Luminal A subtype. However, patients with triple negative subtype did not have a higher risk than patients with Luminal A subtype (OR=1.560; 95%CI:0.658-3.698；P=0.313). Conclusion: Except for other factors, molecular subtype is a independent predictor for NSLN metastasis in patients with a positive SLN. Luminal B and HER2 overexpression subtypes have a higher risk of NSLN metastasis than patients with the Luminal A subtype and triple negative breast cancer.

参考文献/References:

[1] Carter C L, Allen C，Henson D E. Relation of tumor size，lymph node status，and survival in 24，740 breast cancer cases[J]. Cancer， 1989， 63（1）：181
[2] Veronesi U,Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer： update of a randomised controlled study[J]. Lancet Oncol,2006,7（12）：983
[3] Krag D N,Anderson S J, Julian T B, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer： overall survival findings from the NSABP B-32 randomised phase 3 trial[J].Lancet Oncol, 2010, 11（10）：927
[4] Mansel R E, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer：the ALMANAC Trial[J]. J Natl Cancer Inst,2006, 98（9）：599
[5] Hwang R F, Krishnamurthy S, Hunt K K, et al. Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer[J]. Ann Surg Oncol,2003,10（3）：248
[6] Chu K, Turner R R, Hansen N M, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection[J]. Ann Surg, 1999, 229（4）：536
[7] Nos C, Harding-Mackean C, Freneaux P, et al. Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a Woman with breast cancer contains metastases[J]. Br J Surg, 2003, 90（11）：1354
[8] Giuliano A E, Hunt K K, Ballman K V, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis：a randomized clinical trial[J]. JAMA,2011, 305（6）：569
[9] Voduc K D, Cheang M C, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse[J]. J Clin Oncol, 2010, 28（10）：1684
[10] Gangi A, Mirocha J, Leong T, et al. Triple-negative breast cancer is not associated with increased likelihood of nodal metastases[J]. Ann Surg Oncol, 2014, 21（13）：4098
[11] Holm-Rasmussen E V, Jensen M, Balslev E, et al. Reduced risk of axillary lymphatic spread in triple negative breast cancer[J]. Eur J Cancer, 2014, 50（2）：S189
[12] Ashikaga T, Krag D N, Land S R, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection[J]. J Surg Oncol, 2010, 102（2）：111
[13] Lucci A, Mccall L M, Beitsch P D, et al. Surgical complications associated with sentinel lymph node dissection （SLND） plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011[J]. J Clin Oncol, 2007, 25（24）：3657
[14] Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial [J]. Cancer, 1977, 39（6 Suppl）： 2827
[15] Donker M, Straver M E, Van Tienhoven G, et al. Comparison of the sentinel node procedure between patients with multifocal and unifocal breast cancer in the EORTC 10981-22023 AMAROS Trial：identification rate and nodal outcome[J].Eur J Cancer, 2013, 49（9）：2093
[16] Van Zee K J, Manasseh D M, Bevilacqua J L, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy[J]. Ann Surg Oncol, 2003, 10（10）：1140
[17] Boler D E, Uras C, Ince U, et al.Factors predicting the non-sentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases[J].Breast, 2012, 21（4）：518
[18] Kuru B, Sullu Y, Yuruker S, et al. Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases： Presentation of OndokuzMayis scoring system[J]. J BUON, 2016, 21（5）：1129
[19] Chen J Y, Chen J J, Xue J Y, et al.Predicting non-sentinel lymph node metastasis in a chinese breast cancer population with 1-2 positive sentinel nodes： development and assessment of a new predictive nomogram[J]. World J Surg, 2015, 39（12）：2919
[20] Postaci H, Zengel B, Yararbas U, et al. Sentinel lymph node biopsy in breast cancer： predictors of axillary and Non-Sentinel lymph node involvement[J]. Balkan Med J, 2013, 30（4）：415
[21] Gurleyik G, Aker F, Aktekin A, et al. Tumor characteristics influencing non-sentinel lymph node involvement in clinically node negative patients with breast cancer[J]. J Breast Cancer, 2011, 14（2）：124
[22] Crabb S J, Cheang M C, Leung S, et al. Basal breast cancer molecular subtype predicts for lower incidence of axillary lymph node metastases in primary breast cancer[J]. Clin Breast Cancer, 2008, 8（3）：249
[23] Yang Z J, Yu Y E, Hou X W, et al. The prognostic value of node status in different breast cancer subtypes[J]. Oncotarget, 2017, 8（3）：4563
[24] Lee J H, Kim S H, Suh Y J, et al. Predictors of axillary lymph node metastases （ALNM） in a Korean population with T1-2 breast carcinoma： triple negative breast cancer has a high incidence of ALNM irrespective of the tumor size[J]. Cancer Res Treat, 2010, 42（1）：30
[25] Reyal F, Rouzier R, Depont-Hazelzet B, et al. The molecular subtype classification is a determinant of sentinel node positivity in early breast carcinoma[J]. PLoS One, 2011, 6（5）：e20297
[26] Zhou W, He Z, Xue J, et al. Molecular subtype classification is a determinant of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes[J]. PLoS One, 2012, 7（4）：e35881
[27] Reyal F, Belichard C, Rouzier R, et al. Non-sentinel lymph node metastasis prediction in breast cancer with metastatic sentinel lymph node： impact of molecular subtypes classification[J]. PLoS One, 2012, 7（10）：e47390
[28] Gulben K, Berberoglu U, Aydogan O, et al. Subtype is a predictive factor of nonsentinel lymph node involvement in sentinel Node-Positive breast cancer patients[J]. J Breast Cancer, 2014, 17（4）：370

相似文献/References:

[1]朱悦,张诗武,张丹芳,等.TA2小鼠自发乳腺癌血清蛋白质组学研究[J].天津医科大学学报,2013,19(05):373.
[2]刘 营,孙保存,刘铁菊,等.AURKA蛋白激酶在三阴乳腺癌干细胞形成血管拟态中的实验研究[J].天津医科大学学报,2013,19(06):437.
　LIU Ying,SUN Bao-cun,LIU Tie-ju,et al.Experimental study of AURKA protein kinase in the formation of vascular mimicry in triple-negative breast cancer stem cells[J].Journal of Tianjin Medical University,2013,19(05):437.
[3]伦淑敏.HOXA5基因真核表达质粒的构建及在乳腺癌细胞中的功能研究[J].天津医科大学学报,2014,20(05):337.
　LUN Shu-min. Construction of HOXA5 eukaryotic expression plasmid of and its biological significance in breast cancer cells[J].Journal of Tianjin Medical University,2014,20(05):337.
[4]伦淑敏.肌细胞增强因子2A基因真核表达质粒的构建及对乳腺癌细胞MCF-7增殖能力的影响[J].天津医科大学学报,2014,20(06):429.
　LUN Shu-min.Construction of myocyte enhancer factor 2A eukaryotic expression plasmid and effects on cell proliferation in breast cancer cell line MCF7[J].Journal of Tianjin Medical University,2014,20(05):429.
[5]孙秀梅,张 飞,田 然,等.Nanog表达上调促进乳腺癌细胞MCF-7的增殖和侵袭[J].天津医科大学学报,2014,20(06):421.
　SUN Xiu-mei,ZHANG Fei,TIAN Ran,et al.Up-regulation of Nanog promotes cell proliferation and invasion in breast cancer cells MCF-7[J].Journal of Tianjin Medical University,2014,20(05):421.
[6]张 洁,张 飞,冀 为,等. SHP2不同突变体对乳腺癌细胞的迁移和侵袭能力的影响[J].天津医科大学学报,2015,21(02):93.
　ZHANG Jie,ZHANG Fei,JI Wei,et al. Effect of different SHP2 mutants on breast cancer cell migration and invasion[J].Journal of Tianjin Medical University,2015,21(05):93.
[7]蔡 隽. FOXQ1稳定表达乳腺癌细胞系的建立及鉴定[J].天津医科大学学报,2015,21(04):292.
　CAI Jun.Establishment and identification of cell lines with stable expression of FOXQ1 in MDA-MB-231-luc[J].Journal of Tianjin Medical University,2015,21(05):292.
[8]蔡 隽 综述,冯玉梅 审校.叉头框转录因子调控乳腺癌生物学特性的研究进展[J].天津医科大学学报,2015,21(05):455.
[9]任宗娜.沉默Notch4基因对乳腺癌细胞系MDA-MB-231增殖和迁移侵袭能力的影响[J].天津医科大学学报,2015,21(06):469.
　REN Zong-na.Inhibition effect of?silencing?? Notch4 gene on the proliferation and migration and invasion activity of? breast cancer cell line?MDA-MB-231[J].Journal of Tianjin Medical University,2015,21(05):469.
[10]周岩,宋伟杰,张飞,等.人附睾蛋白4在乳腺癌发生发展中的机制研究[J].天津医科大学学报,2015,21(06):466.
　ZHOU Yan,SONG Wei-jie,ZHANG Fei,et al.Mechanism of human epididymis protein 4 in development and progression of breast cancer[J].Journal of Tianjin Medical University,2015,21(05):466.

备注/Memo

备注/Memo:

作者简介 王娜娜（1988-），女，硕士在读，研究方向：乳腺肿瘤；通信作者：张斌，E-mail：eeflying@163.com。

常用功能

更新日期/Last Update: 2018-09-30