Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT)
机构：[1]Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.重庆医科大学附属第一医院[2]Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.[3]Department of Breast and Neck Surgery, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.[4]Department of Breast Surgery, Sichuan Province Tumor Hospital, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China.外科中心乳腺外科中心四川省人民医院四川省肿瘤医院乳腺科[5]Department of Breast Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China.四川省人民医院[6]Breast Disease Center, Southwest Hospital, Third Military Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.重庆医科大学附属第一医院[7]Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.重庆医科大学附属第一医院
Limited studies performed a comprehensive assessment of risk factors for internal mammary lymph nodes (IMLN) metastasis, and disease-free survival (DFS) difference between IMLN-positive and IMLN-negative breast cancer (BC) patients undergoing IMLN dissection and systemic therapies was not clear. A retrospective study included 1977 BC patients from Western China Clinical Cooperation Group between January 2005 and December 2012. The impact of clinicopathological factors on the occurrence of IMLN metastasis was assessed in univariate and multivariate logistic regression analyses, and a nomogram (model) was constructed to predict the IMLN status. DFS difference was evaluated in univariate and multivariate Cox regression analyses between IMLN-negative and IMLN-positive patients, and univariate analysis was performed to compare DFS between individuals with high and low IMLN metastasis risk defined by proposed nomogram. Of 1977 enrolled patients, 514 cases underwent IMLN dissection and 1463 cases did not undergo IMLN irradiation or dissection. We found that initial disease symptoms and signs, mammographic calcification, tumor site, number of positive axillary lymph nodes (ALNs), American Joint Committee on Cancer pT stage, and human epidermal growth factor receptor 2 status were associated with IMLN metastasis (all P<.05). Those variables were included in nomogram, whose predictive ability was better than that of ALN classification (area under the curve: 0.82 vs 0.76, P<.001). Univariate cox proportional hazards model indicated that better DFS was observed in IMLN-negative patients than IMLN-positive group (hazard ratio [HR]=1.87, 95% confidence interval [CI]= 1.05-3.34; P=.04), whereas no significant differences in DFS (HR=0.99, 95% CI=0.49-2.00; P=.97) were found after adjusting patient-, disease-, and treatment-related factors. Nipple inversion, mammographic calcification, larger tumor size, medial tumor site, negative HER-2 status, and more positive ALNs are independent risk factors for IMLN metastasis, and the individualized nomogram is a feasible tool to predict the status of IMLN. Equivalent DFS was found between positive and negative IMLN patients who all accepted IMLN dissection and systemic therapies.
基金：
National Key Clinical Specialty Construction Program of China; Chinese Academy of Medical Sciences; Peking Union Medical College [2014BAI08B03]; Zhejiang Province Key Project of Science and Technology [2014BAI08B00]
第一作者机构：[1]Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
共同第一作者：
通讯作者：
通讯机构：[1]Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.[6]Breast Disease Center, Southwest Hospital, Third Military Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.[7]Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.[*1]Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Youyi Road, Chongqing 400016, China[*2]Breast Disease Center, Southwest Hospital, Third Military Medical University, No. 29 Gaotanyan Street, Chongqing 400038, China
推荐引用方式(GB/T 7714)：
Wang Kang,Zhang Xiang,Zheng Ke,et al.Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT)[J].MEDICINE.2018,97(28):doi:10.1097/MD.0000000000011296.
APA：
Wang, Kang,Zhang, Xiang,Zheng, Ke,Yin, Xue-Dong,Xing, Lei...&Li, Hong-Yuan.(2018).Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT).MEDICINE,97,(28)
MLA：
Wang, Kang,et al."Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients Results from Western China Clinical Cooperation Group (WCCCG) database (CONSORT)".MEDICINE 97..28(2018)
