Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Abstract

Objective:Axillary lymph node dissection (ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node (NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods:The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy (SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph node-negative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results:In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients (32.1%). On univariate analysis, ≥ 3 positive NSLN metastases (P <0.01), NSLN macrometastases ( P = 0.023), and lymphovascular invasion (P = 0.04) were associated with non-NSLN metastasis (P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively. Conclusions:The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with non-SLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial (27.3%); thus, avoiding ALND should be considered carefully.

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

“…In addition, the ALN status remains one of the most important prognostic factors. In our present study, only 266 (37.3%) of the patients with 1–2 SLN metastases in the training cohort were demonstrated to have NSLN metastasis after ALND, which is consistent with the results of previous studies 8 , 20 . Thus, more than 60% of the patients received unnecessary ALND.…”

A nomogram to predict non–sentinel lymph node metastasis in patients with initial cN+ breast cancer that downstages to cN0 after neoadjuvant chemotherapy

“…In patients with zero, one, and at least two SLN metastases, the percentages of positive findings in NSLNs were 3.2%, 24.3%, and 64.6%, respectively. Numerous studies have shown that the tumor burden in metastatic SLNs is associated with NSLN metastasis 16 . Our study found that the proportion of NSLN metastasis increased as the number of SLN metastases increased.…”

“…Positive axillary lymph nodes at baseline may be converted to negative nodes when the primary disease is sensitive to NAC. Many studies have reported various factors contributing to residual axillary disease found in ALND after a positive SNB in patients without NAC 15,16 . Only a few clinical studies have explored the influencing factors of NSLN metastasis in those whose nodal status converted from cN+ to cN0 after NAC.…”

S1PR1 regulates the switch of two angiogenic modes by VE-cadherin phosphorylation in breast cancer

“…In the immunohistochemical analysis of human breast cancer tissue, S1PR1 expression was closely related to lymphatic metastasis 43 . Previously, a large body of experimental evidence has demonstrated that S1PR1 may trigger lymphocyte egress from lymphoid tissues 44,45 .…”