Preoperative total cholesterol and axillary lymph node burden in breast cancer: an exploratory analysis with a...

High axillary lymph node (ALN) burden is an important factor in treatment planning for breast cancer. This study aimed to explore the association between preoperative serum total cholesterol (TC) and high ALN burden and to develop a preliminary risk estimation model.

This retrospective study included 100 patients with primary breast cancer who underwent upfront modified radical mastectomy. High ALN burden was defined as more than four metastatic lymph nodes. Logistic regression analysis was used to assess the association between TC and nodal burden, with adjustment for tumor size. Model performance was evaluated using receiver operating characteristic analysis and bootstrap internal validation.

High ALN burden occurred in 25% of patients. In multivariable analysis, higher TC levels were associated with increased odds of high nodal burden (OR = 1.56 per 1 mmol/L increase; 95% CI: 1.07-2.38; P = 0.026), whereas no statistically significant association was observed in univariate analysis. The optimism-corrected C-index was 0.61, indicating limited discriminative performance. Likelihood ratio testing and AIC comparison showed that inclusion of tumor size did not improve model fit (χ² = 0.17, P = 0.679,AIC 112.67 vs. 110.84). Sensitivity analysis based on TC quartiles did not demonstrate statistically significant differences, and no clear dose-response relationship was observed.

Preoperative total cholesterol was observed to be associated with axillary nodal burden in breast cancer; however, given the limited sample size, low event rate, absence of key confounders, and poor model performance, these findings should be considered exploratory. The proposed model demonstrates limited discriminative ability and is not suitable for clinical application. Further validation in larger, well-designed studies is required.