Chen J-J, Huang X-Y, Liu Z-B, Chen T-W, Cheng J-Y, Yang W-T, Xu W-P, Shao Z-M, Shen Z-Z, Wu J
Department of Breast Surgery, Cancer Hospital/Cancer Institute, Breast Cancer Institute, Fudan University, 399 Ling-Ling Road, Shanghai 200032, China.
Eur J Surg Oncol. 2009 Sep;35(9):921-7. doi: 10.1016/j.ejso.2009.01.009. Epub 2009 Feb 23.
Sentinel lymph node biopsy (SLNB) has become an alternative procedure of axillary lymph node dissection (ALND) with a lower risk of significant operative morbidity. The primary aim of the present study was to evaluate the morbidity and quality-of-life (QoL) after SLNB or ALND. The second aim was to analyze whether the number of SLNs removed was associated with an increased incidence of postoperative morbidity.
From Apr-2006 to Aug-2007, 140 patients treated with SLNB and 81 patients treated with ALND were enrolled in the study. Patients' data were collected preoperatively and at 1, 6, and 12 months after operation. Measurement of arm volume and shoulder function, evaluation of subjective sensory abnormality of both arms and chest wall were performed at every follow-up visit. Besides, patients were required to fill out the simplified Chinese version of the functional assessment of cancer therapy-breast questionnaire at 12 months after operation.
Patients treated with SLNB suffered less morbidity compared with ALND. Elevated body mass index and ALND procedure were independent risk factors associated with postoperative lymphedema. Moreover, patients treated with wide local excision or SLNB had better QoL compared with those treated with mastectomy or ALND. No relationship was observed between the number of SLNs and the morbidity or QoL.
SLNB is associated with a better QoL and less morbidity compared with ALND regardless of the number of SLNs in Chinese women with breast cancer. To limit the number of SLNs less than five did not show any evidence to reduce morbidity.
前哨淋巴结活检（SLNB）已成为腋窝淋巴结清扫术（ALND）的替代手术，具有较低的严重手术并发症风险。本研究的主要目的是评估SLNB或ALND术后的并发症及生活质量（QoL）。第二个目的是分析切除的前哨淋巴结数量是否与术后并发症发生率增加相关。
2006年4月至2007年8月，140例行SLNB治疗的患者和81例行ALND治疗的患者纳入本研究。术前及术后1、6和12个月收集患者数据。每次随访时均测量手臂体积和肩部功能，评估双臂及胸壁的主观感觉异常。此外，要求患者在术后12个月填写癌症治疗-乳腺癌问卷的简体中文版。
与ALND相比，SLNB治疗的患者并发症较少。体重指数升高和ALND手术是与术后淋巴水肿相关的独立危险因素。此外，与接受乳房切除术或ALND的患者相比，接受广泛局部切除或SLNB的患者生活质量更好。未观察到前哨淋巴结数量与并发症或生活质量之间的关系。
在中国乳腺癌女性患者中，无论前哨淋巴结数量多少，SLNB与更好的生活质量和更少的并发症相关。将前哨淋巴结数量限制在少于五个并没有显示出降低并发症的任何证据。
