Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study

被引:48
作者
Bolster, Marieke J.
Peer, Petronella G. M.
Bult, Peter
Thunnissen, Frederik B. J. M.
Schapers, Rene F. M.
Meijer, Jos W. R.
Strobbe, Luc J. A.
van Berlo, Charles L. H.
Klinkenbijl, Jean H. G.
Beex, Louk V. A. M.
Wobbes, Theo
Tjan-Heijnen, Vivianne C. G.
机构
[1] Univ Hosp Maastricht, Dept Med Oncol, NL-6202 AZ Maastricht, Netherlands
[2] Radboud Univ Nijmegen Med Ctr, Dept Surg, Nijmegen, Netherlands
[3] Radboud Univ Nijmegen Med Ctr, Dept Epidemiol & Biostat, Nijmegen, Netherlands
[4] Radboud Univ Nijmegen Med Ctr, Dept Pathol, Nijmegen, Netherlands
[5] Canisius Wilhelmina Hosp, Dept Pathol, Nijmegen, Netherlands
[6] VieCuri Med Ctr, Dept Pathol, Venlo, Netherlands
[7] Rijnstate Hosp, Dept Pathol, Arnhem, Netherlands
[8] Canisius Wilhelmina Hosp, Dept Surg, Nijmegen, Netherlands
[9] VieCuri Med Ctr, Dept Surg, Venlo, Netherlands
[10] Rijnstate Hosp, Dept Surg, Arnhem, Netherlands
[11] Radboud Univ Nijmegen Med Ctr, Dept Med Oncol, Nijmegen, Netherlands
关键词
breast cancer; sentinel lymph node; micro-metastasis; non-sentinel lymph node metastasis; risk factors;
D O I
10.1245/s10434-006-9065-1
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: In this multi-institutional prospective study, we evaluated whether we could identify risk factors predictive for non-sentinel lymph node (non-SN) metastases in breast cancer patients with a positive sentinel lymph node (SN). Methods: In this multi-institutional study, 541 eligible breast cancer patients were included prospectively. Results: The occurrence of non-SN metastases was related to the size of the SN metastasis (P = .02), primary tumor size (P = .001), and lymphovascular invasion (P = .07). The adjusted odds ratio was 3.1 for SN micro-metastasis compared with SN isolated tumor cells, 4.0 for SN macro-metastasis versus SN isolated tumor cells, 3.1 for tumor size (> 3.0 cm compared with <= 3.0 cm), and 2.0 for lymphovascular invasion (yes versus no). There were no positive non-SNs when the primary tumor size was <= 1.0 cm (n = 24) [95% confidence interval (95% CI) 0%-14.0%]. The proportion of positive non-SNs ranged in a prognostic logistic regression model from 9.7% (95% CI 4.0%-23.0%) for patients with SN isolated tumor cells, tumor size of 1.1-3.0 cm, and without vessel invasion, to 72.6% (95% CI 47.0%-89.0%) for patients with SN macro-metastasis, tumor size > 3.0 cm, and with vessel invasion. Conclusion: We identified three predictive factors for non-SN metastases in breast cancer patients with a positive SN: size of the SN metastasis; primary tumor size; and vessel invasion. We were not able to identify a specific group of patients with a positive SN in whom the risk for non-SN metastases was less than 5%.
引用
收藏
页码:181 / 189
页数:9
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