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Abstract
Background Axial lymph node dissection (ALND) is needed in patients with positive sentinel lymph node (SLN). ALND is easy to cause upper limb edema. Therefore, accurate prediction of nonsentinel lymph nodes (non-SLN) which may not need ALND can avoid excessive dissection and reduce complications. We constructed a new prognostic model to predict the non-SLN metastasis of Chinese breast cancer patients. Methods We enrolled 736 patients who underwent sentinel lymph node biopsy (SLNB); 228 (30.98%) were diagnosed with SLNB metastasis which was determined by intraoperative pathological detection and further accepted ALND. We constructed a prediction model by univariate analysis, multivariate analysis, “R” language, and binary logistic regression in the abovementioned 228 patients and verified this prediction model in 60 patients. Results Based on univariate analysis using α = 0.05 as the significance level for type I error, we found that age (P=0.045), tumor size (P=0.006), multifocality (P=0.011), lymphovascular invasion (P=0.003), positive SLN number (P=0.009), and negative SLN number (P=0.034) were statistically significant. Age was excluded in multivariate analysis, and we constructed a predictive equation to assess the risk of non-SLN metastasis: Logit(P)=Ln(P/1 − P)=0.267∗a+1.443∗b+1.078∗c+0.471∗d − 0.618∗e − 2.541 (where “a” represents tumor size, “b” represents multifocality, “c” represents lymphovascular invasion, “d” represents the number of metastasis of SLN, and “e” represents the number of SLNs without metastasis). AUCs for the training group and validation group were 0.715 and 0.744, respectively. When setting the risk value below 22.3%, as per the prediction equation's low-risk interval, our model predicted that about 4% of patients could avoid ALND. Conclusions This study established a model which demonstrated good prognostic performance in assessing the risk of non-SLN metastasis in Chinese patients with positive SLNs.
Highlights
In the 2021 report, the International Agency for Research on Cancer (IARC) showed there were 2.26 million new breast cancer cases in 2020 worldwide, comprising the world’s largest cancer incidence, with a mortality rate that remains the second leading cause of death for women with cancer.China’s annual incidence of new breast cancer cases is 420,000, accounting for 18.6% of the world’s total new breast cancer cases, and it is the largest number of new cancer cases for women in China [1].Early-stage breast cancer is mainly treated with surgery, chemotherapy, endocrine therapy, radiotherapy, or targeted therapy [2, 3]
Axillary lymph node dissection (ALND) has Journal of Oncology been a standard method in breast cancer surgery, since the inception of Halsted radical mastectomy, and has always been the gold standard for assessing axillary lymph node metastasis and determining cancer stage
Ese cases fulfilled the following criteria: (1) primary invasive breast cancer was detected by preoperative needle biopsy or intraoperative freezing pathology, (2) patients met the cT1-3N0M0 stage according to the eighth edition of the American Joint Committee on Cancer (AJCC) staging manual, (3) patients had not received prior neoadjuvant therapy, (4) patients had undergone sentinel lymph node biopsy (SLNB) and tumor metastasis was observed in the sentinel lymph node (SLN), including isolated tumor cells, tumor micrometastases, or macrometastases, (5) an experienced surgical team performed the SLNB, (6) patients accepted further Axial lymph node dissection (ALND), and (7) patients had no prior history of cancer
Summary
In the 2021 report, the International Agency for Research on Cancer (IARC) showed there were 2.26 million new breast cancer cases in 2020 worldwide, comprising the world’s largest cancer incidence, with a mortality rate that remains the second leading cause of death for women with cancer.China’s annual incidence of new breast cancer cases is 420,000, accounting for 18.6% of the world’s total new breast cancer cases, and it is the largest number of new cancer cases for women in China [1].Early-stage breast cancer is mainly treated with surgery, chemotherapy, endocrine therapy, radiotherapy, or targeted therapy [2, 3]. Axillary lymph node dissection (ALND) has Journal of Oncology been a standard method in breast cancer surgery, since the inception of Halsted radical mastectomy, and has always been the gold standard for assessing axillary lymph node metastasis and determining cancer stage Its complications, such as upper limb dysfunction, upper arm lymphedema, and sensory disorders, seriously reduce the patients’ quality of life [4]. With the development of the “precision medicine” surgical treatment approach [5], sentinel lymph node biopsy (SLNB), first introduced for breast cancer surgery by Krag et al [6, 7], has gradually replaced axillary surgery for early breast cancer treatment It is an accurate method for assessing axillary lymph node status that could avoid severe complications and improve postoperative quality of life. Conclusions. is study established a model which demonstrated good prognostic performance in assessing the risk of non-SLN metastasis in Chinese patients with positive SLNs
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