Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Cancer. 2010 Jul 15;116(14):3322-9. doi: 10.1002/cncr.25207.
Several reports have shown a significantly lower number of axillary lymph nodes (AxLNs) found at axillary lymph node dissection (ALND) after neoadjuvant chemotherapy. The objective of the current study was to investigate the factors affecting the number of AxLNs identified at ALND.
Medical records of patients seen at the study institution, a tertiary center, from 2004 to 2007 who underwent ALND for breast cancer were reviewed.
Among the 698 patients who met study criteria, the mean number of AxLNs resected was 20.4. There were 649 (93%) patients with at least 10 AxLNs recovered. Seventy-one (10%) patients received neoadjuvant chemotherapy and 627 (90%) underwent surgical resection first. The mean number of AxLNs in the patients treated with neoadjuvant chemotherapy was 21.9 (range, 4-56 AxLNs) compared with 20.2 (range, 5-65 AxLNs) in the group treated with surgical resection first (P=.13). The number of patients with <10 AxLNs found at ALND was 44 of 627 (7.0%) in the surgical resection first group and 5 of 71 (7.0%) in the neoadjuvant chemotherapy group (P=1.0). The mean number of AxLNs was higher in the 599 (86%) ALNDs performed at the study center compared with the 99 cases from outside institutions (21.2 vs 15.2 AxLNs; P<.001). Among the cases performed at the study institution, 367 (61%) were performed by surgeons with oncologic training and 232 (39%) were not. Surgical oncologists recovered an average of 23 AxLNs, which was significantly higher than the 18.4 resected by the remaining surgeons (P<.001).
The number of AxLNs recovered at ALND does not appear to be affected by neoadjuvant chemotherapy. Surgeons with oncologic training appear to retrieve more AxLNs.
多项研究显示，新辅助化疗后腋窝淋巴结清扫术（ALND）中检出的腋窝淋巴结（AxLNs）数量明显减少。本研究旨在探讨影响 ALND 中 AxLNs 检出数量的因素。
回顾 2004 年至 2007 年在研究机构（三级中心）接受 ALND 治疗的乳腺癌患者的病历资料。
在符合研究标准的 698 例患者中，切除的 AxLNs 平均数量为 20.4 个。有 649（93%）例患者至少回收了 10 个 AxLNs。71（10%）例患者接受新辅助化疗，627（90%）例患者先进行手术切除。接受新辅助化疗的患者的 AxLNs 平均数量为 21.9（范围 4-56 个），而先进行手术切除的患者为 20.2（范围 5-65 个）（P=.13）。先手术切除组中，ALND 发现<10 个 AxLNs 的患者有 44 例（7.0%），新辅助化疗组为 5 例（7.0%）（P=1.0）。研究中心进行的 599 例（86%）ALND 的 AxLNs 数量高于外院的 99 例（21.2 与 15.2 个；P<.001）。在研究机构进行的病例中，367 例（61%）由具有肿瘤学培训的外科医生进行，232 例（39%）不由具有肿瘤学培训的外科医生进行。肿瘤外科医生平均切除 23 个 AxLNs，明显高于其余外科医生的 18.4 个（P<.001）。
ALND 中回收的 AxLNs 数量似乎不受新辅助化疗的影响。具有肿瘤学培训的外科医生似乎可以取出更多的 AxLNs。
