Risk factors of non-sentinel lymph node metastasis in breast cancer with 1–2 sentinel lymph node macrometastases underwent total mastectomy: a case-control study

Abstract

Background The randomized trials which include ACOSOG Z0011 and IBCSG 23-01 had found that the survival rates were not different in patients with cT1/2N0 and 1–2 sentinel lymph node (SLN)-positive, macro/micrometastases who underwent breast-conserving therapy, and micrometastases who underwent total mastectomy (TM), when axillary lymph node dissection (ALND) was omitted. However, for patients with cT1/2N0 and 1–2 SLN macrometastases who underwent TM; there was still insufficient evidence from clinical studies to support whether ALND can be exempted. This study aimed to investigate the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1–2 SLN macrometastases undergoing TM. Methods The clinicopathological data of 1491 breast cancer patients who underwent TM and SLNB from January 2017 to February 2022 were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for nSLN metastasis. Results A total of 273 patients with 1–2 SLN macrometastases who underwent TM were enrolled. Postoperative pathological data showed that 35.2% patients had nSLN metastasis. The results of multivariate analysis indicated that tumor size (TS) (P = 0.002; OR: 1.051; 95% CI: 1.019–1.084) and ratio of SLN macrometastases (P = 0.0001; OR: 12.597: 95% CI: 4.302–36.890) were the independent risk factors for nSLN metastasis in breast cancer patients with 1–2 SLN macrometastases that underwent TM. The ROC curve analysis suggested that when TS ≤22 mm and ratio of SLN macrometastases ≤0.33, the incidence of nSLN metastasis could be reduced to 17.1%. Conclusions The breast cancer patients with cT1/2N0 stage, undergoing TM and 1–2 SLN macrometastases, when the TS ≤22 mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, but whether ALND can be exempted needs further exploration.

Non-sentinel lymph node metastases risk factors in patients with breast cancer with one or two sentinel lymph node macro-metastases

“…Duplicate studies accounted for 516 of these exclusions, whereas screening titles and abstracts resulted in another 1114 exclusions. The full texts of 125 articles were evaluated and 25 studies met the inclusion criteria [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. Fig.…”

“…Table 3 summarizes the findings of the meta-analysis. Three studies examined tumor localization (upper outer quadrant) as a factor [ 15 , 19 , 26 ]; however, one study [ 26 ] reported an error in the 95 % CI [1.506, 0.121], and another study [ 15 ] did not report OR values or 95 % CI. Therefore, the number of exposed and unexposed patients in the case and control groups of the three studies were merged.…”

“…of negative SLNs≥1 6 [ 21 , 22 , 27 , 29 , 36 , 37 ] 65.30 90.8 0.00 1.35 (0.63, 2.93) 0.44 no. of positive SLNs 7 [ 20 , 21 , 23 , 28 , 33 , 37 , 39 ] 19.96 64.9 0.01 2.98 (2.08, 4.26) 0.00 size of SLN metastasis 3 [ 24 , 36 , 37 ] 17.04 88.3 0.00 1.99 (0.82, 4.86) 0.13 SLN metastasis ratio 10 [ [15] , [16] , [17] , [18] , 22 , 23 , 25 , 26 , 32 , 34 ] 96.44 90.7 0.00 2.31 (1.38, 3.85) 0.00 ENE 2 [ 24 , 30 ] 0.13 0 0.72 …”

“…Three studies [ 24 , 36 , 37 ] that reported the size of SLN metastases were ineligible for meta-analysis because two studies [ 24 , 37 ] failed to report the numbers of exposed and unexposed patients in the case and control groups, respectively. Ten studies [ [15] , [16] , [17] , [18] , 22 , 23 , 25 , 26 , 32 , 34 ] assessed the SLN metastasis ratio; however, three studies [ 25 , 26 , 32 ] differed in different layers, and two studies [ 15 , 18 ]failed to report the number of exposed and unexposed patients in the case and control groups; therefore, they could not be included in the analysis.…”