Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Clin Oncol (R Coll Radiol). 2011 Mar;23(2):95-100. doi: 10.1016/j.clon.2010.10.001. Epub 2010 Nov 5.
The optimal management of axillary lymph node metastases from occult breast cancer (TXN1-2M0) is uncertain and practice varies in the use of primary breast radiotherapy. We conducted a retrospective review to examine clinical outcomes for patients managed with or without primary breast radiotherapy.
Case records from the clinical oncology database were reviewed to identify patients presenting with axillary nodal metastases but no detectable primary tumour between 1974 and 2003. Fifty-three patients with TXN1-2M0 breast cancer were identified, representing 0.4% of patients managed for breast cancer during this period. Of those tested, 59% had oestrogen receptor-positive tumours. Seventy-seven per cent received ipsilateral breast radiotherapy.
There was a trend towards reduced ipsilateral breast tumour recurrence in patients who received radiotherapy (16% at 5 years, 23% at 10 years) compared with those who did not (36% at 5 years, 52% at 10 years). Similarly, the locoregional recurrence rate was 28% at 5 years for patients who received radiotherapy compared with 53.7% at 5 years for non-irradiated patients. Breast cancer-specific survival was higher (P=0.0073; Log-rank test) in patients who received ipsilateral breast radiotherapy (72% at 5 years, 66% at 10 years) compared with those who did not (58% at 5 years, 15% at 10 years).
Primary breast radiotherapy may reduce ipsilateral breast tumour recurrence and may increase survival in patients presenting with axillary lymph node metastases and occult breast primary (TXN1-2M0). Larger studies or prospective registration studies are needed to validate these findings.
隐匿性乳腺癌（TXN1-2M0）腋窝淋巴结转移的最佳处理方法尚不确定，在应用原发性乳腺癌放疗方面也存在差异。我们进行了一项回顾性研究，以检查接受或不接受原发性乳腺癌放疗的患者的临床结局。
从临床肿瘤数据库的病历记录中回顾性地识别出 1974 年至 2003 年间出现腋窝淋巴结转移但无法检测到原发性肿瘤的患者。共发现 53 例 TXN1-2M0 乳腺癌患者，占同期乳腺癌患者的 0.4%。在这些患者中，59%的肿瘤雌激素受体阳性。77%的患者接受了同侧乳房放疗。
与未接受放疗的患者相比（5 年时为 36%，10 年时为 52%），接受放疗的患者同侧乳房肿瘤复发的趋势有所降低（5 年时为 16%，10 年时为 23%）。同样，接受放疗的患者局部区域复发率为 5 年时为 28%，而未接受放疗的患者为 5 年时为 53.7%。接受同侧乳房放疗的患者乳腺癌特异性生存率较高（P=0.0073；Log-rank 检验）（5 年时为 72%，10 年时为 66%），而未接受放疗的患者（5 年时为 58%，10 年时为 15%）。
原发性乳腺癌放疗可能降低隐匿性乳腺癌伴腋窝淋巴结转移（TXN1-2M0）患者的同侧乳房肿瘤复发率，并提高生存率。需要更大的研究或前瞻性登记研究来验证这些发现。
