Schijven M P, Vingerhoets A J J M, Rutten H J T, Nieuwenhuijzen G A P, Roumen R M H, van Bussel M E, Voogd A C
Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
Eur J Surg Oncol. 2003 May;29(4):341-50. doi: 10.1053/ejso.2002.1385.
The use of axillary lymph node dissection (ALND) in women with breast cancer is associated with considerable morbidity. Sentinel node biopsy (SNB) removes the lymph node in the axillary basin indicative for receiving first lymphatic drainage from the breast. This study compares the nature and severity of physical morbidity among breast cancer patients who underwent primary surgery for breast cancer combined with either ALND or SNB. Also, it assesses influence of subsequent radiotherapy on morbidity.
Two hundred and thirteen ALND patients were compared with 180 SNB patients retrospectively. Morbidity was measured using a disease-specific quality-of-life questionnaire.
Patients' demographic characteristics were alike. The axillary procedure is the strongest and most consistent factor in explaining differences in a variety of self-reported complaints. Patients having had SNB have a 3.2-fold lower risk of experiencing pain, a 5-fold lower risk of lymph oedema, a 7.7-fold lower risk of numbness, a 3.7-fold lower risk of tingling sensations, a 7.1-fold lower risk of loss of strength in arm/hand, a 3.6-fold lower risk of loss of active motion range of the arm and a 2.9-fold lower risk of impaired use of the arm. Axillary radiation therapy adds to complaints next to the axillary surgical procedure by increasing the risk of lymph oedema 2.4-fold and enhancing the risk of impaired use of the arm by 2.6-fold. Axillary radiation therapy does not explain lymph oedema by itself.
SNB is associated with less morbidity compared to ALND in patients with primary breast cancer.
对乳腺癌女性患者采用腋窝淋巴结清扫术（ALND）会导致相当高的发病率。前哨淋巴结活检（SNB）则是切除腋窝区域中首个接收来自乳腺淋巴引流的淋巴结。本研究比较了接受乳腺癌初次手术并联合ALND或SNB的乳腺癌患者身体发病率的性质和严重程度。此外，还评估了后续放疗对发病率的影响。
回顾性比较213例接受ALND的患者与180例接受SNB的患者。采用特定疾病的生活质量问卷来衡量发病率。
患者的人口统计学特征相似。腋窝手术是解释各种自我报告症状差异的最强且最一致的因素。接受SNB的患者出现疼痛的风险降低3.2倍，出现淋巴水肿的风险降低5倍，出现麻木的风险降低7.7倍，出现刺痛感的风险降低3.7倍，手臂/手部力量丧失的风险降低7.1倍，手臂主动活动范围丧失的风险降低3.6倍，手臂使用功能受损的风险降低2.9倍。除腋窝手术外，腋窝放疗会增加淋巴水肿风险2.4倍，并使手臂使用功能受损风险增加2.6倍，从而加重症状。腋窝放疗本身并不能解释淋巴水肿的发生。
对于原发性乳腺癌患者，与ALND相比，SNB的发病率更低。
