Objective: To investigate the risk factors for non-sentinel lymph node (NSLN) metastasis in early breast cancer with sentinel lymph node (SLN) macrometastasis.  
Methods: The data of 196 patients with clinical early-stage breast cancer and SLN macrometastasis treated from January 2014 to December 2016 were retrospectively collected. The associations of the clinicopathologic variables with NSLN metastasis were analyzed.
Results: Of the 196 patients, NSLN metastasis occurred in 53 cases (25.5%). Univariate analysis showed that NSLN metastasis was not associated with age, menstrual status, primary tumor location, histological grade, vascular tumor thrombus, Ki-67 expression, HER-2 expression, and immunohistochemical type (all P>0.05), but was significantly related to primary tumor size and positive SLN number (both P<0.05). Multivariate regression analysis showed that the positive SLN number was an independent risk factor for NSLN metastasis (P=0.000, OR=2.355).  
Conclusion: The primary tumor size and positive SLN number are important factors for NSLN metastasis in clinical early-stage breast cancer with SLN macrometastasis. For patients with primary tumor size greater than 
2 cm, especially with more than two positive SLN, axillary lymph node dissection is recommended.