Analysis of related risk factors for non<b>-</b>sentinel lymph node metastasis in early breast cancer patients with 1<b>-</b>2 positive sentinel lymph nodes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Jiaxing , GUO Xiaodie , GUAN Guilin ,  ZUO Huaiquan

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

Corresponding author：

ZUO Huaiquan, Email: 13982772996@163.com

Keywords：

early-stage breast carcinoma; sentinel lymph node biopsy; non-sentinel lymph node; axillary lymph node dissection; exemption

DOI：

10.7507/1007-9424.202108020

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Objective To explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. Methods A total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. Results Among the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. Conclusion The number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.

Citation： WU Jiaxing, GUO Xiaodie, GUAN Guilin, ZUO Huaiquan. Analysis of related risk factors for non-sentinel lymph node metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1457-1463. doi: 10.7507/1007-9424.202108020 Copy

1.	Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2.	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.
3.	Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
4.	Gradishar WJ, Moran MS, Abraham J, et al. Breast Cancer, Version 3. 2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2022, 20(6): 691-722.
5.	Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
6.	Bao X, Sun K, Tian X, et al. Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006-2015) retrospective hospitalization summary report-based study. Thorac Cancer, 2018, 9(6): 707-717.
7.	Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol, 2017, 35(5): 561-564.
8.	Liu M, Wang S, Pan L, et al. A new model for predicting non-sentinel lymph node status in Chinese sentinel lymph node positive breast cancer patients. PLoS One, 2014, 9(8): e104117.
9.	Coutant C, Olivier C, Lambaudie E, et al. Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study. J Clin Oncol, 2009, 27(17): 2800-2808.
10.	Reynolds C, Mick R, Donohue JH, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol, 1999, 17(6): 1720-1726.
11.	Chong MH, Luo Z, Zhang JX, et al. Risk factors for non-sentinel lymph node metastasis in Chinese breast cancer patients with one or more sentinel lymph node macrometastases. Asian J Surg, 2022, 45(11): 2343-2344.
12.	Maimaitiaili A, Wu D, Liu Z, et al. Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients. Cancer Biol Med, 2018, 15(3): 282-289.
13.	Liu L, Lin Y, Li G, et al. A novel nomogram for decision-making assistance on exemption of axillary lymph node dissection in T1-2 breast cancer with only one sentinel lymph node metastasis. Front Oncol, 2022, 12: 924298.
14.	Sa-Nguanraksa D, O-Charoenrat E, Kulprom A, et al. Nomogram to predict non-sentinel lymph node status using total tumor load determined by one-step nucleic acid amplification: first report from Thailand. Breast Cancer, 2019, 26(4): 471-477.
15.	Meng L, Zheng T, Wang Y, et al. Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes. Sci Rep, 2021, 11(1): 19972.
16.	Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg, 2012, 255(1): 109-115.
17.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
18.	Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology, 2020, 77(2): 181-185.
19.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版). 中国癌症杂志, 2021, 31(10): 954-1040.
20.	Solá M, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol, 2013, 20(1): 120-127.
21.	Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol, 2014, 15(12): 1303-1310.
22.	Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): e1473-e1480.
23.	Cai SL, Wei RM, Han L, et al. Risk factors of non-sentinel lymph node metastasis in 443 breast cancer patients with sentinel lymph node-positive. Medicine (Baltimore), 2022, 101(29): e29286.
24.	Öz B, Akcan A, Doğan S, et al. Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes. Asian J Surg, 2018, 41(1): 12-19.
25.	Wang NN, Yang ZJ, Wang X, et al. A mathematical prediction model incorporating molecular subtype for risk of non-sentinel lymph node metastasis in sentinel lymph node-positive breast cancer patients: a retrospective analysis and nomogram development. Breast Cancer, 2018, 25(6): 629-638.
26.	Alran S, De Rycke Y, Fourchotte V, et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol, 2007, 14(8): 2195-2201.
27.	Rouzier R, Uzan C, Rousseau A, et al. Multicenter prospective evaluation of the reliability of the combined use of two models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: the MSKCC nomogram and the Tenon score. Results of the NOTEGS study. Br J Cancer, 2017, 116(9): 1135-1140.
28.	Moghaddam Y, Falzon M, Fulford L, et al. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg, 2010, 97(11): 1646-1652.
29.	褚闻聆, 张恩曌, 密雪芳, 等. 前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的影响因素及其预测模型建立. 中华实用诊断与治疗杂志, 2021, 35(4): 376-379.
30.	杨颛搏, 黄州, 王淑莲, 等. 腋窝前哨淋巴结阳性乳腺癌患者腋窝非前哨淋巴结转移风险预测. 中华肿瘤杂志, 2020, 42(8): 653-659.

1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2. 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.
3. Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
4. Gradishar WJ, Moran MS, Abraham J, et al. Breast Cancer, Version 3. 2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2022, 20(6): 691-722.
5. Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
6. Bao X, Sun K, Tian X, et al. Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006-2015) retrospective hospitalization summary report-based study. Thorac Cancer, 2018, 9(6): 707-717.
7. Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol, 2017, 35(5): 561-564.
8. Liu M, Wang S, Pan L, et al. A new model for predicting non-sentinel lymph node status in Chinese sentinel lymph node positive breast cancer patients. PLoS One, 2014, 9(8): e104117.
9. Coutant C, Olivier C, Lambaudie E, et al. Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study. J Clin Oncol, 2009, 27(17): 2800-2808.
10. Reynolds C, Mick R, Donohue JH, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol, 1999, 17(6): 1720-1726.
11. Chong MH, Luo Z, Zhang JX, et al. Risk factors for non-sentinel lymph node metastasis in Chinese breast cancer patients with one or more sentinel lymph node macrometastases. Asian J Surg, 2022, 45(11): 2343-2344.
12. Maimaitiaili A, Wu D, Liu Z, et al. Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients. Cancer Biol Med, 2018, 15(3): 282-289.
13. Liu L, Lin Y, Li G, et al. A novel nomogram for decision-making assistance on exemption of axillary lymph node dissection in T1-2 breast cancer with only one sentinel lymph node metastasis. Front Oncol, 2022, 12: 924298.
14. Sa-Nguanraksa D, O-Charoenrat E, Kulprom A, et al. Nomogram to predict non-sentinel lymph node status using total tumor load determined by one-step nucleic acid amplification: first report from Thailand. Breast Cancer, 2019, 26(4): 471-477.
15. Meng L, Zheng T, Wang Y, et al. Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes. Sci Rep, 2021, 11(1): 19972.
16. Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg, 2012, 255(1): 109-115.
17. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
18. Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology, 2020, 77(2): 181-185.
19. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版). 中国癌症杂志, 2021, 31(10): 954-1040.
20. Solá M, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol, 2013, 20(1): 120-127.
21. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol, 2014, 15(12): 1303-1310.
22. Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): e1473-e1480.
23. Cai SL, Wei RM, Han L, et al. Risk factors of non-sentinel lymph node metastasis in 443 breast cancer patients with sentinel lymph node-positive. Medicine (Baltimore), 2022, 101(29): e29286.
24. Öz B, Akcan A, Doğan S, et al. Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes. Asian J Surg, 2018, 41(1): 12-19.
25. Wang NN, Yang ZJ, Wang X, et al. A mathematical prediction model incorporating molecular subtype for risk of non-sentinel lymph node metastasis in sentinel lymph node-positive breast cancer patients: a retrospective analysis and nomogram development. Breast Cancer, 2018, 25(6): 629-638.
26. Alran S, De Rycke Y, Fourchotte V, et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol, 2007, 14(8): 2195-2201.
27. Rouzier R, Uzan C, Rousseau A, et al. Multicenter prospective evaluation of the reliability of the combined use of two models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: the MSKCC nomogram and the Tenon score. Results of the NOTEGS study. Br J Cancer, 2017, 116(9): 1135-1140.
28. Moghaddam Y, Falzon M, Fulford L, et al. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg, 2010, 97(11): 1646-1652.
29. 褚闻聆, 张恩曌, 密雪芳, 等. 前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的影响因素及其预测模型建立. 中华实用诊断与治疗杂志, 2021, 35(4): 376-379.
30. 杨颛搏, 黄州, 王淑莲, 等. 腋窝前哨淋巴结阳性乳腺癌患者腋窝非前哨淋巴结转移风险预测. 中华肿瘤杂志, 2020, 42(8): 653-659.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of related risk factors for non-sentinel lymph node metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes

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