Department of Surgery, Canisius Wilhelmina Hospital, Weg door jonkerbos 100, Nijmegen, The Netherlands.
Breast Cancer Res Treat. 2013 Jul;140(1):143-9. doi: 10.1007/s10549-013-2608-9. Epub 2013 Jun 23.
As axillary recurrence (AR) after a negative sentinel lymph node biopsy (SLNB) is rare, the prognosis of these patients is unknown. Since treatment paradigms for patients with breast cancer are shifting toward less axillary surgery, the number of ARs might increase. In this study, we evaluated primary and salvage treatment as well as long-term survival of patients diagnosed with an AR. A retrospective analysis of the cancer registry of 16 breast cancer units in the Netherlands was used to identify patients who developed an AR after a negative SLNB performed between 2002 and 2004. Using local hospital records we recorded primary patient-, tumor-, and treatment-characteristics, as well as salvage treatment. We identified 54 patients with an AR, median 30 months (range 3-79) after SLNB. Eighteen patients (33 %) were initially treated with breast conserving therapy, 15 of whom received external beam radiation therapy (EBRT). Thirty-three patients (61 %) did not receive adjuvant systemic treatment. In 45 of the 54 (83 %) patients, a salvage axillary lymph node dissection was performed showing a median of three positive nodes (range 1-24). Nine patients (17 %) were not treated surgically: three were treated with salvage EBRT and six with salvage systemic therapy only. At time of detection of the AR, a total of 7 patients (13 %) had proven distant metastases. After a median follow-up of 47 months (range 3-118), the 5-year "post-recurrence" distant metastasis free survival was 50 % and overall survival was 58 %. Significant negative predictors of survival were negative estrogen receptor (ER) status and receiving adjuvant chemotherapy at initial treatment. AR following a negative SLNB is associated with a 58 % 5-year OS. Prognostic factors are ER- primary tumor and receiving adjuvant chemotherapy as a part of initial treatment, reflecting an aggressive phenotype. Adequate regional and systemic salvage therapy constitute a chance for long-term survival after AR.
由于腋窝复发 (AR) 在阴性前哨淋巴结活检 (SLNB) 后很少见，因此这些患者的预后尚不清楚。由于乳腺癌的治疗模式正在向减少腋窝手术的方向转变，AR 的数量可能会增加。在这项研究中，我们评估了诊断为 AR 患者的初始和挽救治疗以及长期生存情况。使用荷兰 16 个乳腺癌单位的癌症登记处进行回顾性分析，以确定在 2002 年至 2004 年期间进行阴性 SLNB 后发生 AR 的患者。使用当地医院记录，我们记录了患者的原发性、肿瘤和治疗特征，以及挽救治疗。我们确定了 54 例 AR 患者，SLNB 后中位时间为 30 个月（范围 3-79）。18 例患者（33%）最初接受保乳治疗，其中 15 例接受了外部束放射治疗（EBRT）。33 例患者（61%）未接受辅助全身治疗。在 54 例患者中的 45 例（83%）中，进行了挽救性腋窝淋巴结清扫术，显示中位阳性淋巴结数为 3 个（范围 1-24）。9 例患者（17%）未进行手术治疗：3 例接受挽救性 EBRT，6 例仅接受挽救性全身治疗。在 AR 检测时，共有 7 例患者（13%）有远处转移的证据。在中位随访 47 个月（范围 3-118）后，5 年“复发后”远处无转移生存率为 50%，总生存率为 58%。生存的显著负预测因素是雌激素受体（ER）阴性状态和初始治疗时接受辅助化疗。阴性 SLNB 后发生 AR 与 5 年 OS 为 58%相关。预后因素是 ER-原发性肿瘤和作为初始治疗一部分接受辅助化疗，反映了侵袭性表型。充分的区域和全身挽救治疗为 AR 后长期生存提供了机会。
