Hwang Rosa F, Gonzalez-Angulo Ana M, Yi Min, Buchholz Thomas A, Meric-Bernstam Funda, Kuerer Henry M, Babiera Gildy V, Tereffe Welela, Liu Diane D, Hunt Kelly K
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
Cancer. 2007 Aug 15;110(4):723-30. doi: 10.1002/cncr.22847.
The role for completion axillary dissection (CLND) in patients with breast cancer who have tumor-positive sentinel lymph nodes (SLN) has been questioned. The objective of this study was to examine the long-term safety of avoiding CLND in selected patients with positive SLNs.
Patients with invasive breast cancer who underwent SLN biopsy at the authors' institution between 1993 and July 2005 were reviewed. Of 3366 total patients, 750 patients had a positive SLN. There were 196 patients with a positive SLN who did not undergo CLND based on clinician and patient preference. Clinicopathologic variables and treatment patterns were analyzed along with locoregional, distant recurrence, and survival.
Most tumors were infiltrating ductal carcinomas (74%), estrogen receptor-positive tumors (82%), progesterone receptor-positive tumors (70%), HER-2/neu-negative tumors (78.6%), and tumors were classified predominantly as either T1 or T2 (95.4%). The median number of SLNs removed was 3, and the median number of positive SLNs was 1. The median size of the tumor deposit in the SLN was 1.0 mm (range, 0.1-12.9 mm). Most SLNs were positive by on hematoxylin and eosin staining (64.3%), whereas 35.7% of SLNs were positive only by immunohistochemistry. Most patients underwent breast conservation (68.9%), radiation (58.2%), and chemotherapy (neoadjuvant in 14.3%, adjuvant in 55.6%). With a median follow-up of 29.5 months, no patients had an axillary recurrence, 1 patient had a supraclavicular lymph node recurrence, and 3 patients developed distant metastases. The median time to recurrence was 32 months.
In selected patients who had positive SLNs, the locoregional failure rate was low without CLND. Prospective studies will be valuable to corroborate these results and to refine further the optimal selection criteria for this approach.
对于前哨淋巴结（SLN）肿瘤阳性的乳腺癌患者，完成腋窝淋巴结清扫（CLND）的作用受到质疑。本研究的目的是探讨在部分SLN阳性患者中避免进行CLND的长期安全性。
回顾了1993年至2005年7月间在作者所在机构接受SLN活检的浸润性乳腺癌患者。在总共3366例患者中，750例患者的SLN为阳性。有196例SLN阳性患者基于临床医生和患者的偏好未接受CLND。分析了临床病理变量、治疗模式以及局部区域、远处复发和生存情况。
大多数肿瘤为浸润性导管癌（74%）、雌激素受体阳性肿瘤（82%）、孕激素受体阳性肿瘤（70%）、HER-2/neu阴性肿瘤（78.6%），肿瘤主要分类为T1或T2（95.4%）。切除的SLN中位数为3个，阳性SLN中位数为1个。SLN中肿瘤灶的中位数大小为1.0毫米（范围0.1 - 12.9毫米）。大多数SLN苏木精和伊红染色呈阳性（64.3%），而35.7%的SLN仅免疫组化呈阳性。大多数患者接受了保乳治疗（68.9%）、放疗（58.2%）和化疗（新辅助化疗占14.3%，辅助化疗占55.6%）。中位随访29.5个月时，无患者出现腋窝复发，1例患者出现锁骨上淋巴结复发，3例患者发生远处转移。复发的中位时间为32个月。
在部分SLN阳性患者中，不进行CLND时局部区域失败率较低。前瞻性研究对于证实这些结果并进一步完善该方法的最佳选择标准将很有价值。
