Bélanger Julie, Soucy Geneviève, Sidéris Lucas, Leblanc Guy, Drolet Pierre, Mitchell Andrew, Leclerc Yves-Eugène, Beaudet Julie, Dufresne Michel-Pierre, Dubé Pierre
Department of General Surgery, Maisonneuve-Rosemont Hospital, University of Montréal, Montréal, PQ, Canada.
J Am Coll Surg. 2008 Apr;206(4):704-8. doi: 10.1016/j.jamcollsurg.2007.10.016.
It is essential to have the highest level of confidence in axillary staging assessment. Many surgeons and pathologists believe that fewer lymph nodes are present in axillary dissection specimens of women treated by neoadjuvant chemotherapy. Consequently, the purpose of this study was to compare the lymph node counts of axillary dissection specimens from patients having received neoadjuvant chemotherapy with those of patients treated with primary operation.
A retrospective analysis of a prospective database from our institution identified 283 women with invasive breast cancer who underwent level I and II axillary lymph node dissections. Women from the neoadjuvant chemotherapy group (n=107) were compared with those from the primary surgery group (n=176). The total number of lymph nodes harvested was considered as a continuous variable, but also dichotomized into two categories (< 10 and >or=10). Its correlation with the different variables was analyzed.
The median number of lymph nodes retrieved in the neoadjuvant chemotherapy group was 10.0 (range 0 to 38) compared with 12.5 (range 0 to 30) in the control group (p=0.002). There were also significantly more patients with fewer than 10 lymph nodes recovered in the neoadjuvant group (45 versus 28%, p=0.007). Logistic regression showed that neoadjuvant chemotherapy was the only factor associated with retrieval of fewer than 10 lymph nodes.
This study suggests that administration of neoadjuvant chemotherapy to breast cancer patients results in a reduced number of lymph nodes retrieved in the axillary dissection specimens.
对腋窝分期评估要有最高水平的信心至关重要。许多外科医生和病理学家认为，接受新辅助化疗的女性腋窝清扫标本中的淋巴结数量较少。因此，本研究的目的是比较接受新辅助化疗患者与接受初次手术患者腋窝清扫标本中的淋巴结计数。
对我们机构前瞻性数据库进行回顾性分析，确定了283例接受Ⅰ级和Ⅱ级腋窝淋巴结清扫的浸润性乳腺癌女性患者。将新辅助化疗组（n = 107）的女性与初次手术组（n = 176）的女性进行比较。获取的淋巴结总数被视为一个连续变量，但也分为两类（< 10个和≥ 10个）。分析其与不同变量的相关性。
新辅助化疗组获取的淋巴结中位数为10.0（范围0至38），而对照组为12.5（范围0至30）（p = 0.002）。新辅助化疗组中回收淋巴结少于10个的患者也明显更多（45%对28%，p = 0.007）。逻辑回归显示，新辅助化疗是与回收淋巴结少于10个相关的唯一因素。
本研究表明，对乳腺癌患者进行新辅助化疗会导致腋窝清扫标本中回收的淋巴结数量减少。
