China Oncology ›› 2023, Vol. 33 ›› Issue (2): 142-151.doi: 10.19401/j.cnki.1007-3639.2023.02.007
• Specialists' Article • Previous Articles Next Articles
CHEN Yuguang1,2(), SUN Xiao2, BI Zhao1,2, QIU Pengfei1,2, DUAN Baowei1,2,3, FAN Qingda1,2, WANG Yongsheng1,2()
Received:
2022-11-10
Revised:
2023-02-07
Online:
2023-02-28
Published:
2023-03-22
Contact:
WANG Yongsheng
CLC Number:
CHEN Yuguang, SUN Xiao, BI Zhao, QIU Pengfei, DUAN Baowei, FAN Qingda, WANG Yongsheng. Internal mammary sentinel lymph node biopsy for breast cancer: a long-term follow-up research for assessment of prognosis and guiding individualized internal mammary lymph node irradiation[J]. China Oncology, 2023, 33(2): 142-151.
Tab.1
Demographic and clinical characteristics"
Item | Case (n=537) | Percentage/% | Item | Case (n=537) | Percentage/% | |
---|---|---|---|---|---|---|
Age | 48.9±9.0 (27.0-78.0) | Grade | ||||
BMI | 23.9±3.1 (16.4-39.7) | Ⅰ | 9 | 1.7 | ||
Menopausal status | Ⅱ | 326 | 60.7 | |||
No | 331 | 61.6 | Ⅲ | 163 | 30.3 | |
Yes | 206 | 38.4 | N/A | 39 | 7.3 | |
Laterality | No. of ALN positive | |||||
Left | 305 | 56.8 | 0 | 263 | 49.0 | |
Right | 232 | 43.2 | 1-3 | 173 | 32.2 | |
Tumor location | 4-9 | 57 | 10.6 | |||
Lateral | 282 | 52.5 | ≥10 | 44 | 8.2 | |
Central/medial | 248 | 46.2 | IMSLN | |||
Unknown | 7 | 1.3 | Negatvie | 440 | 81.9 | |
Pathological size/cm | Positive | 97 | 18.1 | |||
≤2 | 271 | 50.4 | ER | |||
2-5 | 243 | 45.3 | Negatvie | 133 | 24.8 | |
>5 | 23 | 4.3 | Positive | 404 | 75.2 | |
Histological type | PR | |||||
Ductal | 483 | 89.9 | Negatvie | 168 | 31.3 | |
Lobular | 15 | 2.8 | Positive | 369 | 68.7 | |
Mucinous | 8 | 1.5 | HER2 | |||
Microinfiltration | 23 | 4.3 | Negatvie | 380 | 70.8 | |
Other special types | 8 | 1.5 | Positive | 132 | 24.6 | |
Lymphatic invasion | N/A | 25 | 4.6 | |||
No | 465 | 86.6 | Tumor subtype | |||
Yes | 72 | 13.4 | HR positive/HER2 negatvie | 316 | 58.8 | |
No. of IMSLN | 1.8±0.9 (1-6) | HER2 positive | 132 | 24.6 | ||
Surgery type | TNBC | 64 | 11.9 | |||
Mastectomy | 502 | 93.5 | N/A | 25 | 4.7 | |
Lumpectomy | 35 | 6.5 |
Tab. 2
Univariate and multivariate Cox analysis for DFS and OS after IM-SLNB"
Variables | DFS | OS | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Univariate Cox analysis | Multivariate Cox analysis | Univariate Cox analysis | Multivariate Cox analysis | ||||||||
HR (95% CI) | P value | HR (95% CI) | P value | HR (95% CI) | P value | HR (95% CI) | P value | ||||
IMSLN (positive vs negative) | 5.908 (3.194-10.928) | <0.001 | 3.652 (1.832-7.281) | <0.001 | 6.927 (2.783-17.240) | <0.001 | 3.232 (1.153-9.058) | 0.026 | |||
Age | 0.994 (0.960-1.030) | 0.749 | 1.034 (0.984-1.086) | 0.190 | |||||||
Menopausal status (yes vs no) | 1.338 (0.721-2.480) | 0.356 | 1.712 (0.694-4.222) | 0.243 | |||||||
Tumor location (lateral vs central/medial) | 1.622 (0.871-3.020) | 0.127 | 1.993 (0.785-5.063) | 0.147 | |||||||
No. of positive ALN | 1.121 (1.083-1.160) | <0.001 | 1.090 (1.045-1.137) | <0.001 | 1.138 (1.082-1.196) | <0.001 | 1.100 (1.032-1.173) | 0.003 | |||
Pathological size (cm) | 0.002 | 0.006 | <0.001 | 0.013 | |||||||
2-5 (vs≤2) | 1.484 (0.760-2.899) | 0.248 | 0.769 (0.374-1.577) | 0.473 | 4.430 (1.250-15.700) | 0.021 | 2.597 (0.697-9.673) | 0.155 | |||
>5 (vs≤2) | 5.367 (2.080-13.848) | <0.001 | 3.571 (1.357-9.395) | 0.010 | 17.214 (3.850-76.970) | <0.001 | 9.514 (2.023-44.749) | 0.004 | |||
Histological grade (Ⅲ vs Ⅰ-Ⅱ) | 2.270 (1.230-4.189) | 0.009 | 2.367 (1.273-4.400) | 0.006 | 1.129 (0.429-2.973) | 0.806 | |||||
Lymphatic invasion (yes vs no) | 1.106 (0.433-2.827) | 0.833 | 1.137 (0.261-4.945) | 0.864 | |||||||
ER (ER+ vs ER-) | 0.550 (0.291-1.039) | 0.065 | 0.449 (0.180-1.115) | 0.085 | |||||||
PR (PR+ vs PR-) | 0.668 (0.357-1.252) | 0.208 | 0.575 (0.231-1.429) | 0.233 | |||||||
HER2 (HER2+ vs HER2-) | 1.171 (0.583-2.353) | 0.657 | 1.072 (0.386-2.979) | 0.893 | |||||||
Tumor subtype | 0.219 | 0.209 | |||||||||
HER2+ ( vs HR+/HER2-) | 1.372 (0.657-2.864) | 0.400 | 1.382 (0.463-4.124) | 0.562 | |||||||
TN (vs HR+/HER2-) | 2.049 (0.902-4.653) | 0.087 | 2.683 (0.899-8.011) | 0.077 | |||||||
Radiotherapy (yes vs no) | 1.384 0.731-2.621) | 0.319 | 1.856 (0.686-5.024) | 0.223 |
Fig. 1
Prognosis comparison of the different metastatic statuses of ALN/IMSLN Kaplan-Meier curves showed DFS and OS in all patients. 5-year DFS and OS were described. HR data were also shown. A: Kaplan-Meier DFS and OS in all patients with negative internal mammary sentinel lymph node (IMSLN negative; blue) and positive internal mammary sentinel lymph node (IMSLN positive, red); B: Kaplan-Meier DFS and OS in patients with IMSLN negative (blue) and IMSLN positive (red) in patients with positive axillary lymph nodes (ALN positive) (ALN positive/IMSLN negative vs ALN positive/IMSLN positive). C: Kaplan-Meier DFS and OS in patients with ALN negative/IMSLN negative (orange) and ALN positive/IMSLN positive (green); D: The DFS and OS of the 4 subgroups were shown on this graph. -: Negative; + : Positive."
Fig. 2
Effects of IMNI on the prognosis of patients in different subgroups of IMSLN metastatic status Kaplan-Meier curves showed DFS and OS in all patients who have received radiation therapy. 5-year DFS were described. HR data were also shown. A: Kaplan-Meier DFS and OS in all patients with IMNI (red) and without IMNI (no IMNI, blue). B: Kaplan-Meier DFS and OS in IMSLN negative patients with IMNI (red) and without IMNI (no IMNI, blue). C: Kaplan-Meier DFS and OS in patients with IMSLN negative and ALN 1-3 positive with IMNI (red) and without IMNI (no IMNI, blue). D: Kaplan-Meier DFS and OS in patients with IMSLN-and ALN≥4 positive with IMNI (red) and without IMNI (no IMNI, blue). E: Kaplan-Meier DFS and OS in all IMSLN positive patients with IMNI (orange) and without IMNI (no IMNI, green). -: Negative; + : Positive."
Tab. 3
Hazard ratio (HR) for disease recurrence according to subgroups"
Item | No IMNI (n=142) | IMNI (n=101) | 5-year DFS (IMNI vs no IMNI) | P value | HR (95% CI) |
---|---|---|---|---|---|
T1 | 47 | 39 | 91.9% vs 85.5% | 0.974 | 1.026 (0.228-4.617) |
T2-3 | 95 | 62 | 84.7% vs 90.3% | 0.225 | 1.875 (0.680-5.175) |
N1 | 109 | 41 | 100.0% vs 92.7% | 0.356 | 0.029 (0.000-52.000) |
N2-3 | 29 | 60 | 77.4% vs 74.6% | 0.672 | 1.257 (0.435-3.633) |
Ⅰ-Ⅱ | 100 | 26 | 100.0% vs 95.2% | 0.539 | 0.036 (0.000-1 486.000) |
Ⅲ | 42 | 75 | 82.5% vs 74.6% | 0.919 | 0.952 (0.369-2.458) |
Lateral | 84 | 43 | 87.9% vs 90.1% | 0.872 | 1.145 (0.218-6.009) |
Central/medial | 54 | 57 | 83.4% vs 85.8% | 0.503 | 1.423 (0.506-3.998) |
IMSLN positive | 19 | 67 | 87.3% vs 52.5% | 0.040 | 0.286 (0.087-0.943) |
IMSLN negative | 123 | 34 | 84.5% vs 96.5% | 0.099 | 3.269 (0.488-21.890) |
Tab. 4
IMNI and radiation pneumonia"
RILI | IMSLN- (n=157) | P value | OR (95% CI) | |||
---|---|---|---|---|---|---|
No IMNI (n=123) | IMNI (n=34) | |||||
Grade 1-2 | Grade 3 | Grade 1-2 | Grade 3 | |||
Acute pneumonitis | 7 (5.7%) | 0 (0.0%) | 3 (8.8%) | 0 (0.0%) | 0.883 | 1.465 (0.360-5.960) |
Delayed pneumonitis or fibrosis | 10 (8.1%) | 0 (0.0%) | 10 (29.4%) | 0 (0.0%) | <0.050 | 4.708 (1.870-11.840) |
Total | 17 (13.8%) | 13 (38.2%) | <0.050 | 3.678 (1.604-8.434) | ||
RILI | IMSLN+ (n=86) | P value | OR (95% CI) | |||
No IMNI (n=19) | IMNI (n=67) | |||||
Grade 1-2 | Grade 3 | Grade 1-2 | Grade 3 | |||
Acute pneumonitis | 0 (0.0%) | 0 (0.0%) | 8 (11.9%) | 0 (0.0%) | 0.252 | - |
Delayed pneumonitis or fibrosis | 2 (10.5%) | 0 (0.0%) | 10 (14.9%) | 0 (0.0%) | 0.909 | 1.491 (0.300-7.410) |
Total | 2 (10.5%) | 18(26.8%) | 0.234 | 3.122 (0.700-13.990) |
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