腋窝淋巴结（ALN）的涉及对于预后和乳腺癌患者的多学科治疗至关重要。本研究旨在确定术前临床病理因素对于cN0疾病患者具有四个或更多病理阳性ALN的预测能力，并制定一个预测性诊断模型以指导治疗建议。通过使用机构的前瞻性数据库，本研究确认了1993年至2007年间进行前瞻性哨兵淋巴结活检（SLNB）的绝经后期乳腺癌cN0患者，其中有或无行完全腋窝淋巴结清扫（cALND）的情况。通过逻辑回归分析识别出了在cN0人群中预测四个或更多阳性节点的因素，以及在一个、两个或更多个SLN患者中预测的因素。本研究确定了2532位绝经后期妇女，其中615位（24.3%）接受了cALND。单因素分析结果显示，肿瘤大小、淋巴管性（LVI）、组织学、雌激素受体（ER）阳性状态以及多发性/多中心性与四个或更多阳性节点（n = 63; p < 0.05）有预测关系，而多因素分析结果则显示除了ER状态以外的所有因素均具有显著性。在2532名患者中，1263名（49.2%）患有激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性的疾病，其中30例（2.4%）患者在最终病理结果中发现有四个或更多阳性节点。在只有一个阳性SLN并接受了cALND的130名患者中，有7名患者具有四个或更多阳性节点，其中唯一的预测因素是分级（p = 0.01）。在进行了cALND的33名有两个或更多阳性SLN的患者中，有9名（27.3%）在cALND后具有四个或更多阳性节点，但在这个子组中没有任何预测因素。绝经后期患有早期cN0 HR阳性、HER2阴性乳腺癌且只有一个阳性SLN的女性，其在最终病理学中具有四个或更多阳性节点的风险非常低（5%）。由于N2疾病的风险如此之低，只进行有限的SLNB分期可能足以为这部分患者指导治疗决策。©2023年。外科肿瘤学会。

Axillary lymph node (ALN) involvement is important for prognosis and guidance of multidisciplinary treatment of breast cancer patients. This study sought to identify preoperative clinicopathologic factors predictive of four or more pathologically positive ALNs in patients with cN0 disease and to develop a predictive nomogram to inform therapy recommendations.Using an institutional prospective database, the study identified postmenopausal women with cN0 invasive breast cancer undergoing upfront sentinel lymph node biopsy (SLNB) with or without completion ALND (cALND) between 1993 and 2007. Logistic regression analyses identified factors predictive of four or more positive nodes in the cN0 population and patients with one, two, or more SLNs.The study identified 2532 postmenopausal women, 615 (24.3%) of whom underwent cALND. In the univariate analysis, tumor size, lymphovascular (LVI), histology, estrogen receptor (ER)-positive status, and multifocality/multicentricity were predictive of four or more positive nodes (n = 63; p < 0.05), and all except ER status were significant in the multivariate analysis. Of the 2532 patients, 1263 (49.2%) had hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative disease, and 30 (2.4%) were found to have four or more positive nodes. Of the 130 patients with exactly one positive SLN who underwent cALND (n = 130, 5.4%), 7 had four or more positive nodes, with grade as the only predictive factor (p = 0.01). Of the 33 patients with two or more positive SLNs who underwent cALND, 9 (27.3%) had four or more positive nodes after cALND, but no factors were predictive in this subset.Postmenopausal women with early-stage cN0 HR-positive, HER2-negative breast cancer with a single positive SLN had a very low risk (5%) of having four or more positive nodes on final pathology. With such a low risk of N2 disease, limited staging with SLNB may be sufficient to guide therapy decisions for this subset of patients.© 2023. Society of Surgical Oncology.