Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2012 Oct;19(10):3185-91. doi: 10.1245/s10434-012-2547-4. Epub 2012 Aug 14.
Clinically node-negative breast cancer patients usually undergo sentinel lymph node (SLN) biopsy. When metastasis is identified, completion axillary lymph node dissection (CALND) is recommended. Newer data suggest that CALND may be omitted in some women as it does not improve local control or survival.
Women with a positive SLN diagnosed between 1999 and 2010 were included in this review and were stratified according to whether they did or did not undergo CALND. Primary endpoints included recurrence and breast cancer-specific mortality. Differences between the groups and in time to recurrence were compared and summarized.
Overall, 276 women were included: 206 (79 %) women who underwent CALND (group 1) and 70 (21 %) women in whom CALND was omitted (group 2). Group 1 patients were younger, had more SLN disease, and received more chemotherapy (P < 0.05 for each). The groups did not vary by tumor characteristics (P > 0.05 for each). Median follow-up was 69 (range 6-147) and 73 (range 15-134) months for groups 1 and 2, respectively. Five (2 %) women in group 1 and three (4 %) women in group 2 died of breast cancer (P = 0.39). Local-regional or distant recurrence occurred in 20 (10 %) group 1 patients and in 10 (14 %) group 2 patients (P = 0.39). On multivariate analysis, only estrogen receptor negativity and lymphovascular invasion predicted for recurrence.
Omission of CALND in women with SLN disease does not significantly impact in-breast, nodal, or distant recurrence or mortality. Longer-term follow-up is needed to verify that this remains true with time.
临床上，淋巴结阴性的乳腺癌患者通常会进行前哨淋巴结（SLN）活检。如果发现转移，建议进行辅助腋窝淋巴结清扫术（CALND）。新数据表明，在某些女性中可以省略 CALND，因为它不会改善局部控制或生存。
本研究纳入了 1999 年至 2010 年间诊断为 SLN 阳性的女性，并根据是否行 CALND 进行分层。主要终点包括复发和乳腺癌特异性死亡率。比较并总结了两组之间以及复发时间的差异。
共纳入 276 名女性：206 名（79%）行 CALND 的女性（组 1）和 70 名（21%）CALND 被省略的女性（组 2）。组 1 患者年龄较小，SLN 疾病更多，接受的化疗更多（P<0.05）。两组在肿瘤特征方面没有差异（P>0.05）。组 1 和组 2 的中位随访时间分别为 69（范围 6-147）和 73（范围 15-134）个月。组 1 中有 5 名（2%）女性和组 2 中有 3 名（4%）女性死于乳腺癌（P=0.39）。组 1 中有 20 名（10%）患者和组 2 中有 10 名（14%）患者发生局部区域或远处复发（P=0.39）。多变量分析显示，仅雌激素受体阴性和脉管侵犯预测复发。
在 SLN 疾病患者中省略 CALND 并不会显著影响乳房内、淋巴结或远处复发或死亡率。需要更长时间的随访来验证随着时间的推移这一结果是否仍然成立。
