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乳腺癌是最常见的恶性肿瘤之一。近年来,在全球范围内乳腺癌发病率逐年上升,已成为威胁女性生命健康的第一杀手[1-3],而且呈现出年轻化的势态[4]。有统计资料[5-6]表明,近年来乳腺癌的发病率逐年上升,但是乳腺癌病人的病死率却开始出现下降趋势,这与乳腺癌的早期诊断及转移规律的深入研究密切相关。淋巴道转移是乳腺癌最常见的转移途径,对腋窝淋巴结进行全面清扫,仍是目前获取乳腺癌病人腋窝淋巴结状态的最有效、最准确的检测手段。然而有研究[7]表明,对所有病人进行盲目的预防性腋窝淋巴结清扫并不能有效提高病人的无瘤生存率及总生存率,而病人术后并发症却明显增多,生存质量大受影响。如何准确地获取腋窝淋巴结状态也显得尤为重要。本研究旨在探讨乳腺癌病人腋窝淋巴结转移的相关因素,以期为临床治疗提供相应参考依据。现作报道。
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105例病人中腋窝淋巴结无转移者共60例(57.1%);有转移者共45例(42.9%),其中12例(11.4%)病人阳性淋巴结个数≥10枚,15例(14.3%)个数在4~9个之间,18例(17.1%)个数在1~3个之间。
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结果显示,不同年龄、肿瘤长径、肿瘤部位、组织学分级、病理类型及有无脉管癌栓浸润的乳腺癌病人,腋窝淋巴结转移率差异均有统计学意义(P<0.05~P<0.01)(见表 1)。
影响因素 n 腋窝淋巴结转移 腋窝淋巴结无转移 χ2 P 年龄/岁 ≤35 7 5 2 >35~60 85 31 54 7.44 <0.05 >60 13 9 4 肿瘤长径/cm ≤2 37 10 27 >2~5 49 24 25 6.29 <0.05 >5 19 11 8 肿瘤部位 外上 52 21 31 外下 16 10 6 内上 12 4 8 7.00 <0.05 内下 11 2 9 中央区 14 8 6 分子分型 Luminal A 3 3 0 Luminal B
三阴型69
1730
539
125.27 >0.05 Her-2阳性 16 7 9 脉管癌栓浸润 有 14 14 0 — <0.01* 无 91 31 60 组织学分级 Ⅰ级 5 0 5 Ⅱ级 66 26 40 — <0.05* Ⅲ级 34 19 15 肿瘤个数 多灶 15 8 7 0.78 >0.05 单灶 90 37 53 病理类型 非浸润性癌 6 0 6 浸润性特殊癌 5 1 4 6.17 <0.05 浸润性非特殊癌 94 44 50 *示Fisher′s确切概率法P值 表 1 腋窝淋巴结转移的单因素分析
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以腋窝淋巴结转移为因变量,以年龄、肿瘤长径、肿瘤部位、组织学分级、病理类型及有无脉管癌栓浸润为自变量,进行多因素logistic回归分析。自变量赋值(见表 2)。结果显示,肿瘤长径越长、有脉管癌栓浸润是乳腺癌腋窝淋巴结转移的独立危险因素(P<0.05)(见表 3)。
因素 赋值情况 年龄 ≤35=1;>35~60=2;>60=3 肿瘤长径 ≤2=1;>2~5=2;>5=3 脉管浸润 有=1;无=2 组织学分级 Ⅰ级=1;Ⅱ级=2;Ⅲ级=3 病理类型 非浸润性癌=1;浸润性特殊癌=2;浸润性非特殊癌=3 表 2 多因素logistic回归分析赋值情况表
影响因素 Waldχ2 OR 95%CI P 脉管癌栓浸润 0.27 1.150 1.021~1.653 <0.05 肿瘤长径 2.89 2.142 1.143~7.532 <0.05 表 3 腋窝淋巴结转移影响因素的多因素logistic回归分析
乳腺癌病人腋窝淋巴结转移相关因素分析
Analysis of the related factors of axillary lymph node metastasis in patients with breast cancer
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摘要:
目的分析乳腺癌病人的临床及病理学特征,探寻乳腺癌病人腋窝淋巴结转移的相关因素。 方法回顾性分析105例行外科手术治疗并经病理学确诊为乳腺癌的新发女性病例的临床及病理学资料。分析影响腋窝淋巴结转移的相关因素。 结果105例病人中有45例(42.9%)发生了腋窝淋巴结转移。不同年龄、肿瘤长径、肿瘤部位、组织学分级、病理类型及有无脉管癌栓浸润的乳腺癌病人,腋窝淋巴结转移率差异均有统计学意义(P < 0.05~P < 0.01);多因素logistic分析结果显示,肿瘤长径越长、有脉管癌栓浸润是乳腺癌腋窝淋巴结转移的独立危险因素(P < 0.05)。 结论肿瘤长径和脉管癌栓浸润是腋窝淋巴结转移的独立危险因素。 Abstract:ObjectiveTo analyze the clinicopathological features of breast cancer, and explore the related factors of axillary lymph node metastasis in patients with breast cancer. MethodsThe clinical data of 105 breast cancer patients treated with operation, and diagnosed by pathology, were retrospectively analyzed.The relative factors of axillary lymph node metastasis were investigated. ResultsAmong 105 patients, 45 cases with axillary lymph node metastasis were found, and the metastasis rate was 42.9%.The differences of the age, tumor length, tumor location, histological grade, pathological type, vascular cancer embolus infiltration and axillary lymph node metastasis rate in breast cancer patients were statistically significant(P < 0.05 to P < 0.01).The results of multivariate logistic analysis showed that the long tumor in length diameter and vascular cancer embolus infiltration were the independent risk factors of axillary lymph node metastasis in breast cancer(P < 0.05). ConclusionsThe length diameter of tumor size and tumor vascular invasion are the independent risk factors of axillary lymph node metastasis. -
Key words:
- breast neoplasms /
- female /
- axillary lymph node metastasis
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表 1 腋窝淋巴结转移的单因素分析
影响因素 n 腋窝淋巴结转移 腋窝淋巴结无转移 χ2 P 年龄/岁 ≤35 7 5 2 >35~60 85 31 54 7.44 <0.05 >60 13 9 4 肿瘤长径/cm ≤2 37 10 27 >2~5 49 24 25 6.29 <0.05 >5 19 11 8 肿瘤部位 外上 52 21 31 外下 16 10 6 内上 12 4 8 7.00 <0.05 内下 11 2 9 中央区 14 8 6 分子分型 Luminal A 3 3 0 Luminal B
三阴型69
1730
539
125.27 >0.05 Her-2阳性 16 7 9 脉管癌栓浸润 有 14 14 0 — <0.01* 无 91 31 60 组织学分级 Ⅰ级 5 0 5 Ⅱ级 66 26 40 — <0.05* Ⅲ级 34 19 15 肿瘤个数 多灶 15 8 7 0.78 >0.05 单灶 90 37 53 病理类型 非浸润性癌 6 0 6 浸润性特殊癌 5 1 4 6.17 <0.05 浸润性非特殊癌 94 44 50 *示Fisher′s确切概率法P值 表 2 多因素logistic回归分析赋值情况表
因素 赋值情况 年龄 ≤35=1;>35~60=2;>60=3 肿瘤长径 ≤2=1;>2~5=2;>5=3 脉管浸润 有=1;无=2 组织学分级 Ⅰ级=1;Ⅱ级=2;Ⅲ级=3 病理类型 非浸润性癌=1;浸润性特殊癌=2;浸润性非特殊癌=3 表 3 腋窝淋巴结转移影响因素的多因素logistic回归分析
影响因素 Waldχ2 OR 95%CI P 脉管癌栓浸润 0.27 1.150 1.021~1.653 <0.05 肿瘤长径 2.89 2.142 1.143~7.532 <0.05 -
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