乳腺癌患者胸肌间淋巴结转移的影响因素及手术清扫

摘要

Objective:This study aims to analyze the occurrence rate, positive rate, and other related factors influencing interpec-toral lymph nodes (IPNs) in breast cancer patients. This work further aims to explore the significance and indications of the surgical dis-section of IPNs. Methods:Clinical and pathological data from 1673 breast cancer patients were retrospectively analyzed. All patients were subjected to modified radical mastectomy, and IPNs were pathologically examined. The occurrence rate and metastasis of IPNs were recorded, and the relationship between the IPN positive rate and tumor size, axillary nodes, clinical stages, neo-adjuvant chemo-therapy, hormone receptors, Her-2 expression, and molecular subtypes of breast carcinoma was determined. Results:The occurrence rate, overall metastasis rate, and the positive rate of IPNs in patients with axillary lymph node metastasis were 13.39%, 4.30%, and 10.01%, respectively. IPN metastasis was significantly correlated with axillary node metastasis and the tumor, node and metastasis (TNM) stage of tumors (P<0.05). However, IPN metastasis was not significantly related with hormone receptor and Her-2 expressions. IPN metastasis rate may be unaffected by neo-adjuvant chemotherapy. Patients with IPNs metastasis were characterized by larger tu-mors, more positive axillary lymph nodes, and later TNM stages. Conclusion:IPN metastasis usually occurs in patients with larger tu-mors, more positive axillary lymph nodes, later TNM stages, as well as those with locally advanced cancer that meet the standard of neo-adjuvant chemotherapy. These indications suggest that the surgical dissection and pathological examination of IPNs should be rou-tinely performed.%目的：分析乳腺癌患者胸肌间淋巴结（IPNs）的检出率、转移率及其影响因素，探讨胸肌间淋巴结清扫的意义和指征。方法：回顾性分析1673例接受乳腺癌改良根治术并且胸肌间淋巴结单独送病理检查患者的病理临床资料，记录IPNs的检出率和转移情况，分析IPNs转移与肿瘤大小、腋窝淋巴结、临床分期、新辅助化疗、激素受体、Her-2表达以及乳腺癌分子亚型的关系。结果：本组病例IPNs检出率、IPNs总体转移率、腋窝淋巴结阳性者IPNs转移率分别为13.39%、4.3%和10.01%。IPNs转移率与腋窝淋巴结转移、肿瘤TNM分期之间具有显著相关性（P<0.05），但与激素受体状况、Her-2表达以及乳腺癌分子亚型之间未见相关（P>0.05）；新辅助化疗并未降低肿瘤局部偏晚患者的IPNs转移率；IPNs转移者表现为肿瘤较大、腋窝淋巴结转移多、TNM分期较晚。结论：IPNs转移多见于肿瘤直径较大、腋窝淋巴结转移、TNM分期较晚、局部晚期以及适合新辅助化疗的乳腺癌患者，这些指征可能意味着需要常规进行IPNs的手术清扫和单独送检。