Research of predictive factors of axillary lymph node metastasis in breast cancer under the context of DIP payment of medical insurance

doi:10.11958/20240235

Abstract

Abstract:

Objective To explore the predictive factors of axillary lymph node metastasis in breast cancer, and to provide a basis for clinical decision-making under the DIP payment mode of medical insurance. Methods A total of 715 patients with breast cancer were divided into the metastasis group (n=309) and the non-metastasis group (n=406) according to the postoperative paraffin pathological results. Data of age >60 years old, menopausal status, body mass index (BMI) >24 kg/m², hyperglycemia (GLU >6.1 mmol/L), high triglycerides (TG >1.7 mmol/L), maximum diameter of the tumor, the distance between the tumor and nipple and the quadrant where the tumor located were compared between the two groups. The expression levels of estrogen receptor (ER), progesterone receptor (PR), nuclear proliferation antigen (Ki-67) and human epidermal growth factor receptor-2 (Her-2) in breast cancer tissue samples were detected by histological grading and immunohistochemistry. The consistency, sensitivity and specificity of chest CT and breast ultrasound were examined, taken the pathological diagnosis as the gold standard. Results Compared with the non-metastatic group, the proportion of maximum diameter of tumor>2 cm, histological grade Ⅲ, high Ki-67 and high ER expression, tumor located in the outer upper quadrant, the distance >3 cm between tumor and nipple were increased in the metastatic group, and the proportion of high level of TG was decreased in the metastatic group (P<0.05). The consistency between chest CT and pathological diagnosis was better than that of breast ultrasound (Kappa was 0.493 and 0.353 respectively, P<0.05). Logistic regression analysis showed that histological grade Ⅲ, high expression of ER, maximum diameter of tumor >2 cm, and chest CT diagnosis were risk factors for axillary lymph node metastasis (P<0.05). Conclusion The combined application of the predictive factors of axillary lymph node metastasis of breast cancer could provide certain reference for clinical decision-making under the background of DIP payment mode of medical insurance.

Key words: breast neoplasms, lymph nodes, neoplasm metastasis, Logistic models, chest CT, diagnosis-intervention packet

CLC Number:

R655.8

Figures/Tables 6

References 23

[1]	张雨孟, 林坤河, 陈知禾, 等. 基于政策工具的我国DIP支付方式文本量化分析[J]. 中国卫生事业管理, 2023, 40(12):903-910.
	ZHANG Y M, LIN K H, CHEN Z H, et al. Quantitative analysis of China's DIP payment mode text based on policy tools[J]. Chinese Health Service Management, 2023, 40(12):903-910.
[2]	SMOLARZ B, NOWAK A Z, ROMANOWICZ H. Breast cancer-epidemiology,classification,pathogenesis and treatment(review of literature)[J]. Cancers (Basel), 2022, 14(10):2569. doi:10.3390/cancers14102569.
[3]	ABASS M O, GISMALLA M, ALSHEIKH A A, et al. Axillary lymph node dissection for breast cancer:efficacy and complication in developing countries[J]. J Glob Oncol, 2018, 4:1-8. doi:10.1200/JGO.18.00080.
[4]	王浩宇, 石文达, 赵晓彬, 等. 乳腺癌患者腋窝淋巴结转移的危险因素及行X线摄影与CT检查的诊断效能分析[J]. 河北医学, 2024, 30(3):506-511.
	WANG H Y, SHI W D, ZHAO X B, et al. Risk factors for axillary lymph node metastasis in breast cancer patients and comparative diagnostic efficacy of X-ray imaging and CT scans[J]. Hebei Medicine, 2024, 30(3):506-511. doi:10.3969/j.issn.1006-6233.2024.03.028.
[5]	余卫, 张在竹. 医学领域年龄人群划分标准浅析[J]. 中国医学科学院学报, 2023, 45(2):285-289.
	YU W, ZHANG Z Z. Age-based grouping criteria in medicine[J]. Acta Acad Med Sin, 2023, 45(2):285-289. doi:10.3881/j.issn.1000-503X.15133.
[6]	VON HOLLE A, ADAMI H O, BAGLIETTO L, et al. BMI and breast cancer risk around age at menopause[J]. Cancer Epidemiol, 2024,89:102545. doi:10.1016/j.canep.2024.102545.
[7]	裴蓓, 成琳. 不同分子分型乳腺癌患者预后与淋巴结转移率的相关性分析[J]. 中国肿瘤生物治疗杂志, 2019, 26(7):776-781.
	PEI B, CHENG L. Correlation between lymph node metastasis ratio and prognosis of breast cancer with different molecular subtypes[J]. Chinese Journal of Cancer Biotherapy, 2019, 26(7):776-781. doi:10.3872/j.issn.1007-385x.2019.07.009.
[8]	徐如君, 王炜. 《乳腺癌HER2检测指南(2019版)》中更新部分的解读与探讨[J]. 浙江医学, 2019, 41(14):1461-1463,1476.
	XU R J, WANG W. Interpretation and discussion of the updated part of HER2 detection guidelines for breast cancer (2019 edition)[J]. Zhejiang Medical Journal, 2019, 41(14):1461-1463,1476. doi:10.12056/j.issn.1006-2785.2019.41.14.2019-1200.
[9]	黄霓, 张仕勇, 兰茜琳, 等. 双源CT与MRI在结直肠癌术前分期中的临床价值分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(1):57-61.
	HUANG N, ZHANG S Y, LAN Q L, et al. Clinical value analysis of dual-source CT and MRI in preoperative staging of colorectal cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(1):57-61. doi:10.3877/cma.j.issn.2095-2015.2024.01.010.
[10]	ZHOU W J, ZHANG Y D, KONG W T, et al. Preoperative prediction of axillary lymph node metastasis in patients with breast cancer based on radiomics of gray-scale ultrasonography[J]. Gland Surg, 2021, 10(6):1989-2001. doi:10.21037/gs-21-315.
[11]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi:10.3322/caac.21660.
[12]	HUANG J, CHAN P S, LOK V, et al. Global incidence and mortality of breast cancer: a trend analysis[J]. Aging(Albany NY), 2021, 13(4):5748-5803. doi:10.18632/aging.202502.
[13]	MENG L, ZHENG T, WANG Y, et al. 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[J]. Sci Rep, 2021, 11(1):19972. doi: 10.1038/s41598-021-99522-3.
[14]	GUPTA S, KADAYAPRATH G, AMBASTHA R, et al. False negative rate of sentinel lymph node biopsy on intraoperative frozen section in early breast cancer patients:an institutional experience[J]. Indian J Surg Oncol, 2022, 13(2):312-315. doi:10.1007/s13193-021-01458-7.
[15]	KIM K E, KIM S Y, KO E Y. MRI findings suggestive of metastatic axillary lymph nodes in patients with invasive breast cancer[J]. Taehan Yongsang Uihakhoe Chi, 2022, 83(3):620-631. doi:10.3348/jksr.2021.0097.
[16]	张琳琳, 朱德淼, 闫恒宇, 等. 前哨淋巴结阳性早期乳腺癌患者腋窝非前哨淋巴结转移的危险因素分析[J]. 中国现代医学杂志, 2021, 31(5):15-19.
	ZHANG L L, ZHU D M, YAN H Y, et al. Clinical analysis of risk factors for axillary non-sentinel lymph node metastasis in early breast cancer patients with positive sentinel lymph node[J]. China Journal of Modern Medicine, 2021, 31(5):15-19. doi:10.3969/j.issn.1005-8982.2021.05.003.
[17]	何小艳, 成永莲, 李慧, 等. 乳腺癌雌激素受体、孕激素受体、Ki-67表达与淋巴结转移的相关性研究[J]. 华西医学, 2017, 32(2):226-228.
	HE X Y, CHENG Y L, LI H, et al. The study of correlation between estrogen receptor, progesterone receptor, Ki - 67 and lymph node metastasis in breast cancer[J]. Huaxi medical, 2017, 32(2):226-228.
[18]	廖玉婷, 张嘉文, 张丽君, 等. 乳腺癌淋巴结转移患者的临床病理学特征分析[J]. 医学理论与实践, 2022, 35(7):1209-1211.
	LIAO Y T, ZHANG J W, ZHANG L J, et al. Analysis of clinicopathological features of breast cancer patients with lymph node metastasis[J]. Medical Theory and Practice, 2022, 35(7):1209-1211. doi:10.19381/j.issn.1001-7585.2022.07.056.
[19]	CHEN H, MENG X, HAO X, et al. Correlation analysis of pathological features and axillary lymph node metastasis in patients with invasive breast cancer[J]. J Immunol Res, 2022,2022:7150304. doi:10.1155/2022/7150304.
[20]	RAZA U, ASIF M R, REHMAN A B, et al. Hyperlipidemia and hyper glycaemia in breast cancer patients is related to disease stage[J]. Pak J Med Sci, 2018, 34(1):209-214. doi:10.12669/pjms.341.14841.
[21]	周戌, 肖敏, 李三荣, 等. 乳腺癌组织中E-cad、Ki-67的表达及其与临床病理特征和腋窝淋巴结转移的相关性[J]. 现代肿瘤医学, 2021, 29(13):2287-2291.
	ZHOU X, XIAO M, LI S R, et al. Relationship between expression of E-cad and Ki-67 and clinicopathological features and axillary lymph node metastasis in breast cancer tissues[J]. Modern Oncology, 2021, 29(13):2287-2291.
[22]	刘家伟. 三阴性乳腺癌患者腋窝淋巴结转移的危险因素分析及其预测模型的建立[J]. 江苏医药, 2024, 50(3):276-280.
	LIU J W. Risk factor analysis of axillary lymph node metastasis in triple-negative breast cancer patients and the establishment of its prediction model[J]. Jiangsu Medical Journal, 2024, 50(3):276-280. doi:10.19460/j.cnki.0253-3685.2024.03.014.
[23]	孙喜燕, 宁伟, 王谦, 等. 超声自动乳腺全容积成像表现对乳腺癌腋窝淋巴结转移的预测价值及乳腺癌腋窝淋巴结转移的危险因素分析[J]. 中国医刊, 2024, 59(3):329-332.
	SUN X Y, NING W, WANG Q, et al. The predictive value of ultrasound automated full volume breast imaging for axillary lymph node metastasis in breast cancer and the risk factors of axillary lymph node metastasis in breast cancer[J]. Chin J Med, 2024, 59(3):329-332.

组别	n	年龄>60岁	绝经	BMI>24 kg/m²		肿瘤距乳头距离>3 cm
非转移组	406	78（19.2）	188（46.3）	251（61.8）		176（43.3）
转移组	309	62（20.1）	138（44.7）	203（65.7）		102（33.0）
χ²		0.081	0.191	1.136		7.894^＊＊
组别	肿瘤最大直径>2 cm	肿瘤位于乳房外上象限	高TG		高血糖
非转移组	194（47.8）	246（60.6）	96（23.6）		66（16.3）
转移组	213（68.9）	177（57.3）	49（15.9）		57（18.4）
χ²	32.005^＊＊	14.527^＊＊	6.582^＊		0.591

组别	n	年龄>60岁	绝经	BMI>24 kg/m²		肿瘤距乳头距离>3 cm
非转移组	406	78（19.2）	188（46.3）	251（61.8）		176（43.3）
转移组	309	62（20.1）	138（44.7）	203（65.7）		102（33.0）
χ²		0.081	0.191	1.136		7.894^＊＊
组别	肿瘤最大直径>2 cm	肿瘤位于乳房外上象限	高TG		高血糖
非转移组	194（47.8）	246（60.6）	96（23.6）		66（16.3）
转移组	213（68.9）	177（57.3）	49（15.9）		57（18.4）
χ²	32.005^＊＊	14.527^＊＊	6.582^＊		0.591

组别	n	组织学分级 Ⅲ级	Ki-67高表达	Her-2 阳性	PR 高表达	ER 高表达
非转移组	406	150（37.0）	234（57.6）	220（54.2）	207（51.0）	267（65.8）
转移组	309	167（54.1）	209（67.6）	177（57.3）	175（56.6）	229（74.1）
χ²		28.717^＊＊	7.447^＊＊	0.680	2.250	5.753^＊

组别	n	组织学分级 Ⅲ级	Ki-67高表达	Her-2 阳性	PR 高表达	ER 高表达
非转移组	406	150（37.0）	234（57.6）	220（54.2）	207（51.0）	267（65.8）
转移组	309	167（54.1）	209（67.6）	177（57.3）	175（56.6）	229（74.1）
χ²		28.717^＊＊	7.447^＊＊	0.680	2.250	5.753^＊

诊断方法	诊断结果	病理结果
诊断方法	诊断结果	转移	未转移
胸部CT	转移	255	129
	未转移	54	277
乳腺彩超	转移	222	145
	未转移	87	261