Author's Affiliation: University of Michigan Comprehensive Cancer Center, Michigan.
Cancer Res. 2013 Dec 15;73(24):7156-60. doi: 10.1158/0008-5472.CAN-13-2094.
For breast cancer patients, the role of the axillary lymph node dissection (ALND) in the management of clinically node negative breast cancer patient has shifted from routine, to selective, to increasingly rare. With the publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial results, some are ready to announce the time of death of this procedure. However, many questions remain regarding the design and statistical interpretation of the study, the treatments the patients actually received, and its applicability in clinical practice in light of other studies concerning regional management. Thus, the reports of the ALND's death may be greatly exaggerated. Careful acknowledgement of the study's strengths and shortcomings, and more recent trial data, suggest that although ALND may be safely avoided in a subset of sentinel lymph node positive, Z0011-eligible patients, others may require multidisciplinary review and consensus, and a careful conversation with the patient, before deciding it is not necessary.
对于乳腺癌患者，腋窝淋巴结清扫术（ALND）在临床淋巴结阴性乳腺癌患者管理中的作用已经从常规、选择性转变为越来越罕见。随着美国外科医师学院肿瘤学组（ACOSOG）Z0011 试验结果的公布，一些人准备宣布该手术的时代已经结束。然而，关于该研究的设计和统计解释、患者实际接受的治疗以及鉴于其他有关区域管理的研究，其在临床实践中的适用性，仍存在许多问题。因此，ALND 导致死亡的报告可能被大大夸大了。仔细了解研究的优缺点以及最近的试验数据表明，尽管在一小部分前哨淋巴结阳性、符合 Z0011 标准的患者中可以安全地避免 ALND，但其他患者可能需要多学科的审查和共识，并与患者进行仔细的讨论，然后才能决定是否不需要进行 ALND。
