Tokita Hiromi, Aruga Tomoyuki, Yamashita Toshinari, Saji Shigehira, Suzuki Eiji, Horiguchi Kazumi, Kitagawa Dai, Sekine Susumu, Horiguchi Shin-ichiro, Hirashima Yuka, Kuroi Katsumasa
Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Gan To Kagaku Ryoho. 2011 Oct;38(10):1639-45.
We investigated predictors for axillary node metastasis at breast surgery after neoadjuvant chemotherapy (NAC) in patients with pre-chemotherapy-sentinel node positive breast cancer.
Eighty-two patients were diagnosed as having positive sentinel lymph node (SLN), who had axillary lymph node dissection (ALND) performed after combination anthracycline/taxan based NAC, between 2002 and 2009.
Eighteen (22.0%) of the 82 patients had residual axillary metastases after NAC. Multivariate analysis revealed that SLNs status before NAC was an important factor in predicting residual axillary metastases. Predictors of residual nodal disease were the number of macrometastases and the percentage (>50%) of positive SLNs in all SLNs. Among a subgroup of hormone-receptor positive and HER2-negative tumors, the risk of residual nodal metastases were high sensitivity of hormone receptor, with more than 50% of tumor cells staining positive for ER and PgR.
Patients with two or more positive SLNs before NAC had a high risk of residual nodal metastasis after NAC.
我们研究了新辅助化疗（NAC）后接受乳腺手术的化疗前前哨淋巴结阳性乳腺癌患者腋窝淋巴结转移的预测因素。
2002年至2009年间，82例被诊断为前哨淋巴结（SLN）阳性的患者在接受基于蒽环类/紫杉类联合NAC后进行了腋窝淋巴结清扫（ALND）。
82例患者中有18例（22.0%）在NAC后有残留腋窝转移。多因素分析显示，NAC前的SLN状态是预测残留腋窝转移的重要因素。残留淋巴结疾病的预测因素是大转移灶数量以及所有SLN中阳性SLN的百分比（>50%）。在激素受体阳性且HER2阴性肿瘤的亚组中，残留淋巴结转移风险高的是激素受体高敏感性，即超过50%的肿瘤细胞ER和PgR染色阳性。
NAC前有两个或更多阳性SLN的患者在NAC后有残留淋巴结转移的高风险。
