Division of Senology, Unit of Molecular Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
Breast Cancer Res Treat. 2012 Feb;131(3):819-25. doi: 10.1007/s10549-011-1486-2. Epub 2011 Apr 6.
There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive in early breast cancer, particularly when involvement is minimal (micrometastases or isolated tumor cells). To address this issue we analyzed outcomes in patients with a single micrometastatic SN who did not receive AD. We selected 377 consecutive patients treated at the European Institute of Oncology between 1999 and 2007 for invasive breast cancer. Classical and competing risks survival analyses were performed to estimate prognostic factors for axillary recurrence, first events and overall survival. Median age was 53 years (range 26-80); median follow-up was 5 years (range 1-9). Most (91.8%) patients received conservative surgery; 209 (55.4%) had only one SN (range 1-8). Five-year overall survival was 97.3%. There were 10 local events, 2 simultaneous local and axillary events, 6 axillary recurrences and 12 distant events. The cumulative incidence of axillary recurrence was 1.6% (95% CI 0.7-3.3). By multivariable analysis, tumor size and grade were significantly associated with axillary recurrence. The high five-year survival and low cumulative incidence of axillary recurrence in this cohort provide justification for the increasingly common practice of foregoing AD in women with minimal SN involvement, and suggest in particular that AD can safely be avoided in women with small, low-grade tumors. Nevertheless, a subset of patients might be at high risk of developing overt axillary disease and efforts should be made to identify such patients by ancillary analyses of the results of ongoing or recently published clinical trials.
对于早期乳腺癌中前哨淋巴结（SN）阳性，尤其是当SN 仅存在微小转移（微转移或孤立肿瘤细胞）时，人们对省略腋窝清扫（AD）的做法很感兴趣。为了解决这个问题，我们分析了未接受 AD 的单一微转移 SN 患者的结局。我们选择了 1999 年至 2007 年在欧洲肿瘤研究所治疗的连续 377 例浸润性乳腺癌患者。为了估计腋窝复发、首发事件和总生存的预后因素，我们进行了经典和竞争风险生存分析。中位年龄为 53 岁（范围 26-80）；中位随访时间为 5 年（范围 1-9）。大多数（91.8%）患者接受了保乳手术；209 例（55.4%）只有一个 SN（范围 1-8）。5 年总生存率为 97.3%。有 10 例局部事件，2 例局部和腋窝同时发生的事件，6 例腋窝复发和 12 例远处转移事件。腋窝复发的累积发生率为 1.6%（95%CI 0.7-3.3）。多变量分析表明，肿瘤大小和分级与腋窝复发显著相关。该队列的高 5 年生存率和低腋窝复发累积发生率为最小 SN 受累的女性省略 AD 提供了理由，并表明 AD 可以安全地避免小、低分级肿瘤的女性。然而，仍有一部分患者可能存在发生显性腋窝疾病的高风险，应通过对正在进行或最近发表的临床试验结果进行辅助分析，努力识别出此类患者。
