The analysis of risk factors for axillary lymph node metastasis in patients with Luminal A breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Song ,  QUAN Yi

Department of Breast Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

QUAN Yi, Email: 20783833@qq.com

Keywords：

Luminal A breast cancer; axillary lymph node metastasis; risk factor

DOI：

10.7507/1007-9424.202008110

Video：

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Objective The study was aimed to further explore risk factors of axillary lymph node metastasis in Luminal A breast cancer and revealed high-risk clinicopathological features.Methods From January 2017 to December 2019, the clinical and pathological data of 237 Luminal A breast cancer patients diagnosed in our hospital were retrospectively analyzed. For the identification of related risk factors of axillary lymph node metastasis in Luminal A breast cancer, χ² test for univariate analysis and logistic regression model for multivariate analysis were conducted.Results Among the 237 patients with Luminal A breast cancer, 115 patients were associated with lymph node metastasis (48.5%). The univariate analysis indicated that multifocal tumor (P=0.001), p53 mutation (P=0.012), and lymphovascular invasion (P=0.022) were correlated with axillary lymph node metastasis in the Luminal A breast cancer. The multivariate analysis identically showed that multifocal tumor (P=0.009), p53 mutation (P=0.019), and lymphovascular invasion (P=0.021) were independent risk factors of axillary lymph node metastasis.Conclusion Multifocal breast cancer, p53 mutation, and lymphovascular invasion are risk factors of axillary lymph node metastasis in Luminal A breast cancer.

Citation： WANG Song, QUAN Yi. The analysis of risk factors for axillary lymph node metastasis in patients with Luminal A breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 789-793. doi: 10.7507/1007-9424.202008110 Copy

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2.	Holm J, Eriksson L, Ploner A, et al. Assessment of breast cancer risk factors reveals subtype heterogeneity. Cancer Res, 2017, 77(13): 3708-3717.
3.	Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
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5.	Lawrenson R, Lao C, Campbell I, et al. The impact of different tumour subtypes on management and survival of New Zealand women with Stage Ⅰ -Ⅲ breast cancer. N Z Med J, 2018, 131(1475): 51-60.
6.	谢菲, 王珏, 朱倩男, 等. 乳腺癌分子分型与腋窝淋巴结转移的临床研究. 中国肿瘤外科杂志, 2018, 10(3): 147-149.
7.	Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA, 2017, 318(10): 918-926.
8.	Park S, Moon BI, Oh SJ, et al. Clinical subtypes and prognosis in breast cancer according to parity: a nationwide study in Korean Breast Cancer Society. Breast Cancer Res Treat, 2019, 173(3): 679-691.
9.	Allison KH, Hammond MEH, Dowsett M, et al. Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med, 2020, 144(5): 545-563.
10.	Wolff AC, Hammond MEH, Allison KH, et al. HER2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update Summary. J Oncol Pract, 2018, 14(7): 437-441.
11.	Aman NA, Doukoure B, Koffi KD, et al. Immunohistochemical evaluation of Ki-67 and comparison with clinicopathologic factors in breast carcinomas. Asian Pac J Cancer Prev, 2019, 20(1): 73-79.
12.	李健斌, 江泽飞. 2019 年 CSCO BC 指南更新要点解读. 中国肿瘤外科杂志, 2019, 11(3): 155-160.
13.	Bae SY, Lee JH, Bae JW, et al. Differences in prognosis by p53 expression after neoadjuvant chemotherapy in triple-negative breast cancer. Ann Surg Treat Res, 2020, 98(6): 291-298.
14.	Zhang Y, Li J, Fan Y, et al. Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients. Medicine (Baltimore), 2019, 98(40): e17481.
15.	Kondov B, Kondov G, Spirovski Z, et al. Prognostic factors on the positivity for metastases of the axillary lymph nodes from primary breast cancer. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2017, 38(1): 81-90.
16.	Chung MJ, Lee JH, Kim SH, et al. Simple prediction model of axillary lymph node positivity after analyzing molecular and clinical factors in early breast cancer. Medicine (Baltimore), 2016, 95(20): e3689.
17.	Fushimi A, Yoshida A, Yagata H, et al. Prognostic impact of multifocal and multicentric breast cancer versus unifocal breast cancer. Surg Today, 2019, 49(3): 224-230.
18.	Pedersen L, Gunnarsdottir KA, Rasmussen BB, et al. The prognostic influence of multifocality in breast cancer patients. Breast, 2004, 13(3): 188-193.
19.	Lang Z, Wu Y, Li C, et al. Multifocal and multicentric breast carcinoma: a significantly more aggressive tumor than unifocal breast cancer. Anticancer Res, 2017, 37(8): 4593-4598.
20.	Cabioglu N, Ozmen V, Kaya H, et al. Increased lymph node positivity in multifocal and multicentric breast cancer. J Am Coll Surg, 2009, 208(1): 67-74.
21.	Wang X, Simpson ER, Brown KA. p53: protection against tumor growth beyond effects on cell cycle and apoptosis. Cancer Res, 2015, 75(23): 5001-5007.
22.	Pan Y, Yuan Y, Liu G, et al. P53 and Ki-67 as prognostic markers in triple-negative breast cancer patients. PLoS One, 2017, 12(2): e0172324.
23.	Payandeh M, Sadeghi M, Sadeghi E, et al. Expression of p53 breast cancer in kurdish women in the west of Iran: A reverse correlation with lymph node metastasis. Asian Pac J Cancer Prev, 2016, 17(3): 1261-1264.
24.	Dihge L, Bendahl PO, Rydén L. Nomograms for preoperative prediction of axillary nodal status in breast cancer. Br J Surg, 2017, 104(11): 1494-1505.
25.	Chakraborty A, Bose CK, Basak J, et al. Determinants of lymph node status in women with breast cancer: a hospital based study from eastern India. Indian J Med Res, 2016, 143(Supplement): S45-S51.
26.	Xie X, Xiong Z, Li X, et al. Nomogram to predict internal mammary lymph nodes metastasis in patients with breast cancer. Front Oncol, 2019, 9: 1193.
27.	Poudel P, Nyamundanda G, Patil Y, et al. Heterocellular gene signatures reveal luminal-A breast cancer heterogeneity and differential therapeutic responses. NPJ Breast Cancer, 2019, 5: 21.
28.	Ciriello G, Sinha R, Hoadley KA, et al. The molecular diversity of Luminal A breast tumors. Breast Cancer Res Treat, 2013, 141(3): 409-420.

1. Ellsworth RE, Blackburn HL, Shriver CD, et al. Molecular heterogeneity in breast cancer: state of the science and implications for patient care. Semin Cell Dev Biol, 2017, 64(1): 65-72.
2. Holm J, Eriksson L, Ploner A, et al. Assessment of breast cancer risk factors reveals subtype heterogeneity. Cancer Res, 2017, 77(13): 3708-3717.
3. Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
4. Oboma YI, Susan BE, Elesha SO, et al. Breast cancer biomarkers at Niger delta university hospital: comparisons with national and international trends and clinical significance. Pathophysiology, 2017, 24(3): 191-196.
5. Lawrenson R, Lao C, Campbell I, et al. The impact of different tumour subtypes on management and survival of New Zealand women with Stage Ⅰ -Ⅲ breast cancer. N Z Med J, 2018, 131(1475): 51-60.
6. 谢菲, 王珏, 朱倩男, 等. 乳腺癌分子分型与腋窝淋巴结转移的临床研究. 中国肿瘤外科杂志, 2018, 10(3): 147-149.
7. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA, 2017, 318(10): 918-926.
8. Park S, Moon BI, Oh SJ, et al. Clinical subtypes and prognosis in breast cancer according to parity: a nationwide study in Korean Breast Cancer Society. Breast Cancer Res Treat, 2019, 173(3): 679-691.
9. Allison KH, Hammond MEH, Dowsett M, et al. Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med, 2020, 144(5): 545-563.
10. Wolff AC, Hammond MEH, Allison KH, et al. HER2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update Summary. J Oncol Pract, 2018, 14(7): 437-441.
11. Aman NA, Doukoure B, Koffi KD, et al. Immunohistochemical evaluation of Ki-67 and comparison with clinicopathologic factors in breast carcinomas. Asian Pac J Cancer Prev, 2019, 20(1): 73-79.
12. 李健斌, 江泽飞. 2019 年 CSCO BC 指南更新要点解读. 中国肿瘤外科杂志, 2019, 11(3): 155-160.
13. Bae SY, Lee JH, Bae JW, et al. Differences in prognosis by p53 expression after neoadjuvant chemotherapy in triple-negative breast cancer. Ann Surg Treat Res, 2020, 98(6): 291-298.
14. Zhang Y, Li J, Fan Y, et al. Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients. Medicine (Baltimore), 2019, 98(40): e17481.
15. Kondov B, Kondov G, Spirovski Z, et al. Prognostic factors on the positivity for metastases of the axillary lymph nodes from primary breast cancer. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2017, 38(1): 81-90.
16. Chung MJ, Lee JH, Kim SH, et al. Simple prediction model of axillary lymph node positivity after analyzing molecular and clinical factors in early breast cancer. Medicine (Baltimore), 2016, 95(20): e3689.
17. Fushimi A, Yoshida A, Yagata H, et al. Prognostic impact of multifocal and multicentric breast cancer versus unifocal breast cancer. Surg Today, 2019, 49(3): 224-230.
18. Pedersen L, Gunnarsdottir KA, Rasmussen BB, et al. The prognostic influence of multifocality in breast cancer patients. Breast, 2004, 13(3): 188-193.
19. Lang Z, Wu Y, Li C, et al. Multifocal and multicentric breast carcinoma: a significantly more aggressive tumor than unifocal breast cancer. Anticancer Res, 2017, 37(8): 4593-4598.
20. Cabioglu N, Ozmen V, Kaya H, et al. Increased lymph node positivity in multifocal and multicentric breast cancer. J Am Coll Surg, 2009, 208(1): 67-74.
21. Wang X, Simpson ER, Brown KA. p53: protection against tumor growth beyond effects on cell cycle and apoptosis. Cancer Res, 2015, 75(23): 5001-5007.
22. Pan Y, Yuan Y, Liu G, et al. P53 and Ki-67 as prognostic markers in triple-negative breast cancer patients. PLoS One, 2017, 12(2): e0172324.
23. Payandeh M, Sadeghi M, Sadeghi E, et al. Expression of p53 breast cancer in kurdish women in the west of Iran: A reverse correlation with lymph node metastasis. Asian Pac J Cancer Prev, 2016, 17(3): 1261-1264.
24. Dihge L, Bendahl PO, Rydén L. Nomograms for preoperative prediction of axillary nodal status in breast cancer. Br J Surg, 2017, 104(11): 1494-1505.
25. Chakraborty A, Bose CK, Basak J, et al. Determinants of lymph node status in women with breast cancer: a hospital based study from eastern India. Indian J Med Res, 2016, 143(Supplement): S45-S51.
26. Xie X, Xiong Z, Li X, et al. Nomogram to predict internal mammary lymph nodes metastasis in patients with breast cancer. Front Oncol, 2019, 9: 1193.
27. Poudel P, Nyamundanda G, Patil Y, et al. Heterocellular gene signatures reveal luminal-A breast cancer heterogeneity and differential therapeutic responses. NPJ Breast Cancer, 2019, 5: 21.
28. Ciriello G, Sinha R, Hoadley KA, et al. The molecular diversity of Luminal A breast tumors. Breast Cancer Res Treat, 2013, 141(3): 409-420.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The analysis of risk factors for axillary lymph node metastasis in patients with Luminal A breast cancer

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