腋窝手术对淋巴结阴性原发性乳腺癌女性患者局部复发及生存的影响。
Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer.
作者信息
Axelsson C K, Düring M, Christiansen P M, Wamberg P A, Søe K L, Møller S
机构信息
Department F of Breast Surgery, Herlev University Hospital, Copenhagen, Denmark.
出版信息
Br J Surg. 2009 Jan;96(1):40-6. doi: 10.1002/bjs.6350.
BACKGROUND
This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies.
METHODS
The follow-up analyses were based on 8657 patients with node-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years.
RESULTS
The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant metastases (from 15.0 to 10.3 per cent; P < 0.001) and death as first event (from 7.5 to 5.5 per cent; P = 0.012).
CONCLUSION
When ALND is indicated, at least ten axillary lymph nodes should be retrieved. The role of ALND as primary treatment has decreased significantly during the past decade. The findings leave the concept of the sentinel node biopsy intact, as a highly specific procedure compared to ALND.
背景
本研究探讨了如近期研究所报道的，切除多个正常淋巴结的腋窝淋巴结清扫术（ALND）是否能降低腋窝复发率并提高生存率。
方法
随访分析基于8657例仅接受手术治疗的淋巴结阴性原发性乳腺癌患者。中位随访时间为9年。
结果
切除的淋巴结数量与随后腋窝复发率的降低相关（从2.1%降至0.4%；P = 0.037）、局部复发率降低（从7.4%降至3.8%；P < 0.001）、远处转移率降低（从15.0%降至10.3%；P < 0.001）以及作为首要事件的死亡率降低（从7.5%降至5.5%；P = 0.012）。
结论
当有指征进行ALND时，应至少切除10个腋窝淋巴结。在过去十年中，ALND作为主要治疗方法的作用已显著下降。这些发现使前哨淋巴结活检的概念保持不变，因为与ALND相比，它是一种高度特异性的手术。
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