Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo

Detalhes bibliográficos
Autor(a) principal: Henrique Silva Bartels
Data de Publicação: 2010
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFMG
Texto Completo: http://hdl.handle.net/1843/ECJS-85BN9C
Resumo: BACKGROUND: According to the standard of care for breast cancer patients, complete axillary lymph node dissection (ALND) is performed when sentinel lymph node (SLN) presents metastasis. However, 40 to 70% of patients with positive SLN are found to have no other metastasis in non sentinel lymph node (NSLN) and the value of complete axillary lymph node dissection (ALND) has been questioned. The aim of our study was to evaluate risk factors for NSLN metastasis in patients with positive-SLN. PACIENTS AND METHODS: We reviewed 326 cases of patients with breast cancer and positive-SLN divided into two groups according to the nodal involvement in the ALND: patients with all NSLN negative for metastasis and patients with at least one positive NSLN. Clinical features of the patients, pathological features of the primary tumor (tumor size, histological tumor type and grade, mitotic index, nuclear grade, invasion of blood and lymphatic vessels, estrogen and progesterone receptors status) and SLN (number of positive and negative SLN, detection method of metastasis and size of the largest metastasis) were assessed. Data were submitted to univariate and multivariate logistic regression to evaluate the risk of metastasis in the NSLN, followed by construction of a mathematical model (nomogram) to predict the presence of additional disease in the non-SLN of these patients. The accuracy of the proposed nomogram was measured by the area under (AUC) the receiver operating characteristic curve (ROC curve).RESULTS: The univariate and multivariate analyses identified the following risk factors for involvement of NSLN with the respective p values: size of the largest SLN metastasis (p < 0.001, p = 0.002), number of positive SLN (p = 0.006, p = 0.04) and number of negative SLN (p = 0.01, p = 0.004). Invasion of lymphatic vessels showed p values of 0.075 and 0.085 (not statistically significant) but was also included in the nomogram. The nomogram showed an accuracy of 70% (AUC = 0.70).CONCLUSIONS: Our data showed that size of the largest SLN metastasis and number of positive and negative SLN were predictive risk factors for metastatic involvement of NSLN in patients with positive-SLN. These data must be informed in the SLN report. Our nomogram, similar to other models, may represent an additional tool to help physicians and patients who decide whether or not a complete ALND should be performed.
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spelling Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivoMetástaseCâncerFatores de riscoMamaSentinelaLinfonodoMetástase neoplásicaAnálise multivariadaLinfonodosMamas CâncerNeoplasias da mamaFatores de riscoNomogramasBiópsia de linfonodo sentinelaBACKGROUND: According to the standard of care for breast cancer patients, complete axillary lymph node dissection (ALND) is performed when sentinel lymph node (SLN) presents metastasis. However, 40 to 70% of patients with positive SLN are found to have no other metastasis in non sentinel lymph node (NSLN) and the value of complete axillary lymph node dissection (ALND) has been questioned. The aim of our study was to evaluate risk factors for NSLN metastasis in patients with positive-SLN. PACIENTS AND METHODS: We reviewed 326 cases of patients with breast cancer and positive-SLN divided into two groups according to the nodal involvement in the ALND: patients with all NSLN negative for metastasis and patients with at least one positive NSLN. Clinical features of the patients, pathological features of the primary tumor (tumor size, histological tumor type and grade, mitotic index, nuclear grade, invasion of blood and lymphatic vessels, estrogen and progesterone receptors status) and SLN (number of positive and negative SLN, detection method of metastasis and size of the largest metastasis) were assessed. Data were submitted to univariate and multivariate logistic regression to evaluate the risk of metastasis in the NSLN, followed by construction of a mathematical model (nomogram) to predict the presence of additional disease in the non-SLN of these patients. The accuracy of the proposed nomogram was measured by the area under (AUC) the receiver operating characteristic curve (ROC curve).RESULTS: The univariate and multivariate analyses identified the following risk factors for involvement of NSLN with the respective p values: size of the largest SLN metastasis (p < 0.001, p = 0.002), number of positive SLN (p = 0.006, p = 0.04) and number of negative SLN (p = 0.01, p = 0.004). Invasion of lymphatic vessels showed p values of 0.075 and 0.085 (not statistically significant) but was also included in the nomogram. The nomogram showed an accuracy of 70% (AUC = 0.70).CONCLUSIONS: Our data showed that size of the largest SLN metastasis and number of positive and negative SLN were predictive risk factors for metastatic involvement of NSLN in patients with positive-SLN. These data must be informed in the SLN report. Our nomogram, similar to other models, may represent an additional tool to help physicians and patients who decide whether or not a complete ALND should be performed.INTRODUÇÃO: Atualmente, recomenda-se a realização de esvaziamento axilar (EA) quando o linfonodo sentinela (LS) apresenta metástases de câncer de mama. Entretanto, 40 a 70% das pacientes com biópsia de linfonodo sentinela (BLS) positiva não apresentam metástases nos linfonodos não-sentinela e o EA tem sido questionado nestes casos. OBJETIVOS: Os objetivos de nosso estudo foram avaliar os fatores de risco para ocorrência de metástases em linfonodos não-sentinela em pacientes com LS positivo e propor um modelo matemático (nomograma) para predição do risco de acometimento dos linfonodos não-sentinela no EA nestas pacientes. PACIENTES E MÉTODOS: Foram analisadas 326 pacientes com câncer de mama e BLS positiva divididas em dois grupos de acordo com o acometimento de linfonodos não-sentinela no EA: pacientes com todos linfonodos não-sentinela negativos e pacientes com pelo menos um linfonodo não-sentinela positivo. Características clínicas das pacientes e anatomopatológicas dos tumores primários (tamanho tumoral, tipo e grau histológico, índice mitótico, grau nuclear, invasão de vasos sanguíneos e linfáticos, status dos receptores de estrógeno e progesterona) e dos LS (número de LS positivos e negativos, método de detecção da metástase e tamanho da maior metástase) foram coletados. Os dados foram submetidos às análises uni e multivariada com regressão logística, seguidas da construção de um modelo matemático (nomograma) para predição do risco de acometimento dos linfonodos não-sentinela no EA em pacientes com BLS positiva. A acurácia do nomograma proposto foi medida através da área (AUC) sob a curva de características operacionais de recepção (curva ROC). RESULTADOS: As análises uni e multivariada identificaram os seguintes fatores de risco para acometimento de linfonodos não-sentinela com os respectivos valores de p: tamanho da maior metástase do LS (p<0,001; p=0,002), número de LS positivos (p=0,006; p=0,04) e número de LS negativos (p=0,01; p=0,004). A invasão de vasos linfáticos apresentou níveis significância próximos (p=0,075, p=0,085) àquele considerado estatisticamente significativo e também foi incluída no nomograma. O nomograma apresentou acurácia de 70% (AUC=0,70). CONCLUSÕES: Nossos dados mostraram que o tamanho da maior metástase do LS e o número de LS positivos e negativos parecem ser fatores de risco preditivos para o acometimento metastático de linfonodos não-sentinela em pacientes com BLS positiva. Sugerimos incluir estes dados nos laudos patológicos do LS. Nosso nomograma, similar a outros modelos disponíveis na literatura, pode representar uma ferramenta adicional para ajudar médicos e pacientes na decisão de realizar ou não EA em pacientes com BLS positiva.Universidade Federal de Minas GeraisUFMGHelenice GobbiVanessa Fortes Zschaber MarinhoMarcio de Almeida SallesLAGE, E.M.Henrique Silva Bartels2019-08-11T06:20:46Z2019-08-11T06:20:46Z2010-02-08info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://hdl.handle.net/1843/ECJS-85BN9Cinfo:eu-repo/semantics/openAccessporreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMG2019-11-14T08:35:33Zoai:repositorio.ufmg.br:1843/ECJS-85BN9CRepositório InstitucionalPUBhttps://repositorio.ufmg.br/oairepositorio@ufmg.bropendoar:2019-11-14T08:35:33Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
dc.title.none.fl_str_mv Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
title Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
spellingShingle Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
Henrique Silva Bartels
Metástase
Câncer
Fatores de risco
Mama
Sentinela
Linfonodo
Metástase neoplásica
Análise multivariada
Linfonodos
Mamas Câncer
Neoplasias da mama
Fatores de risco
Nomogramas
Biópsia de linfonodo sentinela
title_short Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
title_full Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
title_fullStr Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
title_full_unstemmed Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
title_sort Fatores de risco para metástases em linfonodos não-sentinela com câncer de mama e linfonodo sentinela positivo
author Henrique Silva Bartels
author_facet Henrique Silva Bartels
author_role author
dc.contributor.none.fl_str_mv Helenice Gobbi
Vanessa Fortes Zschaber Marinho
Marcio de Almeida Salles
LAGE, E.M.
dc.contributor.author.fl_str_mv Henrique Silva Bartels
dc.subject.por.fl_str_mv Metástase
Câncer
Fatores de risco
Mama
Sentinela
Linfonodo
Metástase neoplásica
Análise multivariada
Linfonodos
Mamas Câncer
Neoplasias da mama
Fatores de risco
Nomogramas
Biópsia de linfonodo sentinela
topic Metástase
Câncer
Fatores de risco
Mama
Sentinela
Linfonodo
Metástase neoplásica
Análise multivariada
Linfonodos
Mamas Câncer
Neoplasias da mama
Fatores de risco
Nomogramas
Biópsia de linfonodo sentinela
description BACKGROUND: According to the standard of care for breast cancer patients, complete axillary lymph node dissection (ALND) is performed when sentinel lymph node (SLN) presents metastasis. However, 40 to 70% of patients with positive SLN are found to have no other metastasis in non sentinel lymph node (NSLN) and the value of complete axillary lymph node dissection (ALND) has been questioned. The aim of our study was to evaluate risk factors for NSLN metastasis in patients with positive-SLN. PACIENTS AND METHODS: We reviewed 326 cases of patients with breast cancer and positive-SLN divided into two groups according to the nodal involvement in the ALND: patients with all NSLN negative for metastasis and patients with at least one positive NSLN. Clinical features of the patients, pathological features of the primary tumor (tumor size, histological tumor type and grade, mitotic index, nuclear grade, invasion of blood and lymphatic vessels, estrogen and progesterone receptors status) and SLN (number of positive and negative SLN, detection method of metastasis and size of the largest metastasis) were assessed. Data were submitted to univariate and multivariate logistic regression to evaluate the risk of metastasis in the NSLN, followed by construction of a mathematical model (nomogram) to predict the presence of additional disease in the non-SLN of these patients. The accuracy of the proposed nomogram was measured by the area under (AUC) the receiver operating characteristic curve (ROC curve).RESULTS: The univariate and multivariate analyses identified the following risk factors for involvement of NSLN with the respective p values: size of the largest SLN metastasis (p < 0.001, p = 0.002), number of positive SLN (p = 0.006, p = 0.04) and number of negative SLN (p = 0.01, p = 0.004). Invasion of lymphatic vessels showed p values of 0.075 and 0.085 (not statistically significant) but was also included in the nomogram. The nomogram showed an accuracy of 70% (AUC = 0.70).CONCLUSIONS: Our data showed that size of the largest SLN metastasis and number of positive and negative SLN were predictive risk factors for metastatic involvement of NSLN in patients with positive-SLN. These data must be informed in the SLN report. Our nomogram, similar to other models, may represent an additional tool to help physicians and patients who decide whether or not a complete ALND should be performed.
publishDate 2010
dc.date.none.fl_str_mv 2010-02-08
2019-08-11T06:20:46Z
2019-08-11T06:20:46Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/1843/ECJS-85BN9C
url http://hdl.handle.net/1843/ECJS-85BN9C
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de Minas Gerais
UFMG
publisher.none.fl_str_mv Universidade Federal de Minas Gerais
UFMG
dc.source.none.fl_str_mv reponame:Repositório Institucional da UFMG
instname:Universidade Federal de Minas Gerais (UFMG)
instacron:UFMG
instname_str Universidade Federal de Minas Gerais (UFMG)
instacron_str UFMG
institution UFMG
reponame_str Repositório Institucional da UFMG
collection Repositório Institucional da UFMG
repository.name.fl_str_mv Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)
repository.mail.fl_str_mv repositorio@ufmg.br
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