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

• Main Authors: Amina Maimaitiaili, Di Wu, Zhenyu Liu, Haimeng Liu, Xiamusiye Muyiduli, Zhimin Fan
• Format: Article
• Language: English
• Published: China Anti-Cancer Association 2018-09-01
• Series: Cancer Biology & Medicine
• Subjects: Breast cancer; sentinel lymph node metastasis; axillary lymph node dissection; non-sentinel lymph node metastasis
• Online Access: http://www.cancerbiomed.org/index.php/cocr/article/view/1183

<b>Objective: </b> 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.<b>Methods:</b> 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.<b>Results: </b> 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 (<i>P</i> &lt;0.01), NSLN macrometastases (<i>P</i> = 0.023), and lymphovascular invasion (<i>P</i> = 0.04) were associated with non-NSLN metastasis (<i>P</i> &lt;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.<b>Conclusions: </b> 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.