Zakaria Shaheen, Pantvaidya Gouri, Reynolds Carol A, Grant Clive S, Sterioff Sylvester, Donohue John H, Farley David R, Hoskin Tanya L, Degnim Amy C
Department of Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
Surgery. 2008 May;143(5):641-7. doi: 10.1016/j.surg.2007.10.023. Epub 2008 Feb 13.
Little data address outcome in patients with sentinel lymph node (SN) metastases without completion axillary lymph node dissection (CALND). This study was designed to assess locoregional recurrence in patients with positive SNs who did not undergo CALND.
An IRB-approved, retrospective chart review was conducted on breast cancer patients with a positive SN. Follow-up information on outcomes was obtained via mailed questionnaires and chart review. Comparative analyses were performed between patients who did and did not undergo CALND after a positive sentinel lymph node biopsy.
From November 1998 to June 2004, 625 breast cancer patients had a positive sentinel lymph node biopsy. One-hundred and eighteen patients with < or = 0.2 mm nodal metastases (N0i+) were excluded from the study. Of the remaining 507 patients, 421 underwent CALND and 86 did not. In comparison to patients who had CALND, patients who did not undergo CALND had smaller primary tumors (2 vs 2.6 cm, P = .0007) and were more likely to have a single positive sentinel node (92% vs 77%, P = .002). The metastasis size of the sentinel node was smaller compared to patients who underwent axillary dissection (1.7 vs 6.4 mm, P < .0001). Mean predicted probability of nonsentinel node metastasis in patients who did not undergo CALND was 20% compared to 47% in patients who did (P < .0001). During a median follow-up of 30 months, there were no axillary recurrences.
These data confirm that patients who have a positive sentinel node biopsy and do not undergo CALND have a lower risk profile for axillary disease. In this lower risk subset, axillary treatment may not be necessary.
关于前哨淋巴结（SN）转移但未行腋窝淋巴结清扫术（CALND）患者的预后数据较少。本研究旨在评估未接受CALND的SN阳性患者的局部区域复发情况。
对经机构审查委员会批准的SN阳性乳腺癌患者进行回顾性病历审查。通过邮寄问卷和病历审查获取结局的随访信息。对前哨淋巴结活检阳性后接受和未接受CALND的患者进行比较分析。
1998年11月至2004年6月，625例乳腺癌患者前哨淋巴结活检阳性。118例淋巴结转移≤0.2 mm（N0i+）的患者被排除在研究之外。在其余507例患者中，421例行CALND，86例未行。与接受CALND的患者相比，未接受CALND的患者原发肿瘤较小（2 cm对2.6 cm，P = 0.0007），且更可能仅有一个前哨淋巴结阳性（92%对77%，P = 0.002）。与接受腋窝清扫的患者相比，前哨淋巴结的转移灶较小（1.7 mm对6.4 mm，P < 0.0001）。未接受CALND的患者非前哨淋巴结转移的平均预测概率为20%，而接受CALND的患者为47%（P < 0.0001）。在中位随访30个月期间，无腋窝复发。
这些数据证实，前哨淋巴结活检阳性且未接受CALND的患者腋窝疾病风险较低。在这个低风险亚组中，可能无需行腋窝治疗。
