Axiller lenf nodu pozitif meme kanserinde non-sentinel lenf nodu pozitifliğine etki eden faktörler ve nomogramların etkinliğinin karşılaştırılması

Amaç: Amacımız aksiller lenf nodu pozitif meme kanserinde nonsentinel lenf nodu (NSLN) pozitifliğine etki eden faktörleri araştırmak ve hasta grubumuzda Memorial Sloan-Kettering Cancer Center (MSKCC) ve Stanford nomogramlarının etkinliğini karşılaştırmaktır. Yöntemler: 01.01.2008 - 31.08.2011 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği’nde sentinel lenf nodu biyopsisi (SLNB) sonucunda sentinel lenf nodunda metastaz saptanan invaziv meme kanseri olan 112 hasta çalışmaya alındı. Karşılaştırılacak değişkenler SPSS 15.0 versiyonu programından yararlanılarak kaydedildi. Lojistik regresyon analizi ile NSLN pozitifliğine etki eden risk faktörleri araştırıldı. P< 0.05 anlamlılık düzeyi olarak kabul edildi. Her iki nomogram icin “Receiver Operating Characteristics (ROC)” eğrileri oluşturuldu ve eğriler altındaki alanlar(AUC) hesaplandı. AUC değeri 0.70 ve üzerinde hesaplanan yöntem etkin olarak kabul edildi. Bulgular: Tek değişkenli analizde tümör boyutu, multifokalite, lenfovasküler invazyon varlığı, SLN’daki metastazın makrometastaz oluşu, SLN’da kapsül dışı invazyon varlığı ve metastatik SLN sayısının toplam SLN sayısına oranı anlamlı bulundu. Çok değişkenli analizde lenfovasküler invazyon, SLN’da kapsül dışı invazyon ve metastatik SLN sayısının toplam SLN sayısına oranı NSLN metastazı ile ilgili bağımsız prediktif faktörler olarak saptandı. MSKCC ve Stanford nomogramlarının ikisinin de hasta grubumuzda etkin olmakla birlikte MSKCC nomogramının daha etkin olduğu sonucuna vardık. Sonuç: Nomogramlar aksillada NSLN’unda metastataz olasılığı hakkında yol gösterici yöntemlerdir. Ancak henüz aksiller lenf nodu diseksiyonunun (ALND) yerini alacak kapasitede değildirler. NSLN pozitifliğine etki eden yeni prediktif faktörlerin ortaya konulması ile etkinlikleri artırılabilir. Her klinik kendisine en uygun nomogramı belirlemeli ve kullanmalı veya kendi nomogramını oluşturmalıdır.

Comparison of factors affecting non-sentinel lymph node positivity and nomogram efficacy in axillary lymph node positive breast cancer

Objective: Our aim is to investigate the factors that affect non-sentinel lymph node positivity in patients with axillary lymph node positive breast cancer and to evaluate the effectiveness of Memorial Sloan-Kettering Cancer Center (MSKCC) and Stanford nomograms in our patients group. Methods: One hundred and twelve invasive breast cancer patients with metastatic sentinel lymph node biopsy (SLNB) who underwent surgery, between January 2008 and August 2011, in Department of General Surgery at Ondokuz Mayıs University School of Medicine were included in the study. Variables that will be compared with were recorded by using SPSS 15.0 version. Risk factors which effect the non sentinel lymph node positivity were analysed by logistic regression analysis. P < 0.05 was considered as significant. Receiver operating characteristics (ROC) curves for nomograms were created and area under curves (AUC) were computed. AUC values equal to or greater than 0.70 have been accepted as good discrimination for prediction of non-sentinel lymph node metastasis. Results: In univariate analysis, tumor size, presence of multifocality, lenfovascular invasion, metastatic sentinel lymph node with macrometastasis and extracapsular invasion, the ratio of number of metastatic sentinel lymph node to total number of sentinel lymph node were found to be significant. In multivariate analysis, presence of lenfovascular invasion, extracapsul invasion and the ratio of number of metastatic sentinel lymph node to total number of sentinel lymph node were found to be independent factors for metastatic non-sentinel lymph node. For our patients group we conluded that the both of MSKCC and Stanford nomograms were effective. Conclusion: Nomograms are methods to predict the possibility of non sentinel lymphnode metastasis. But they have yet not the ability to replace axillary lymph node dissection. Their effectiveness can be increased by new predictive factors for non-sentinel lymph node positivity. Each clinic should determine and use most suitable nomogram or should create own nomogram.

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