Keruakous Amany R, Sadek Betro T, Shenouda Mina N, Niemierko Andrzej, Abi Raad Rita F, Specht Michelle, Smith Barbara L, Taghian Alphonse G
Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Cox 3 Building, 100 Blossom St., Boston, MA, USA, 02114.
Breast Cancer Res Treat. 2014 Jul;146(2):365-70. doi: 10.1007/s10549-014-3027-2. Epub 2014 Jun 22.
To compare the outcome of patients with invasive breast cancer, who had isolated tumor cells (ITC) in sentinel lymph nodes, pN0(i+), to patients with histologically negative nodes, pN0. We retrospectively studied 1,273 patients diagnosed with T1-T3 breast cancer from 1999 to 2009. Patients were divided into 2 populations: 807 patients treated with breast-conserving surgery (BCS) and radiotherapy (RT), 85(10.5 %) with pN0(i+) and 722(89.5 %) with pN0. And the other population had 466 patients treated with mastectomy without post-mastectomy radiation therapy (PMRT), 80(17.2 %) with pN0(i+),and 386(82.8 %)with pN0. All patients underwent sentinel node biopsy, and the presence of ITC was determined. Patients with axillary dissection only or neoadjuvant chemotherapy were excluded. Among the 1,273 patients studied; 87.3 % received adjuvant systemic therapy. Kaplan-Meier, Cox regression, and log-rank statistical tests were used. Median patient age was 55.7 years. Median follow-up was 69.5 months. The 5- and 10-year cumulative incidence of Loco-regional recurrence (LRR) for patients treated with BCS and RT was 1.6 and 3.5 % for 85 pN0(i+) patients, and 2.4 and 5 % for 722 pN0 patients, respectively. For patients treated with mastectomy without PMRT, 5- and 10-year LRR rates were 2.8 and 2.8 % for 80 pN0(i+) patients, and 1.8 and 3 % for 386 pN0 patients, respectively. There were no statistically significant differences in LRR (p = 0.9), distant recurrence (p = 0.3) ,and overall survival (p = 0.5) among all groups. On multivariate analysis, ITC were not associated with increased risk of LRR, distant recurrence and overall survival. Grade (p = 0.003) and systemic therapy (p = 0.02) were statistically significantly associated with risk of LRR. Sentinel node ITC have no significant impact on LRR, distant recurrence and overall survival in breast cancer patients. Additional treatments such as axillary dissection, chemotherapy, or regional radiation should not be given solely based on the presence of sentinel node ITC.
为比较前哨淋巴结中存在孤立肿瘤细胞（ITC）的浸润性乳腺癌患者（pN0(i+)）与组织学检查淋巴结阴性的患者（pN0）的预后。我们回顾性研究了1999年至2009年期间诊断为T1 - T3期乳腺癌的1273例患者。患者分为两组：807例行保乳手术（BCS）加放疗（RT）的患者，其中85例（10.5%）为pN0(i+)，722例（89.5%）为pN0。另一组有466例行乳房切除术且未行乳房切除术后放疗（PMRT）的患者，其中80例（17.2%）为pN0(i+)，386例（82.8%）为pN0。所有患者均接受了前哨淋巴结活检，并确定是否存在ITC。仅行腋窝淋巴结清扫术或接受新辅助化疗的患者被排除。在研究的1273例患者中；87.3%接受了辅助全身治疗。采用Kaplan - Meier法、Cox回归分析和对数秩检验。患者中位年龄为55.7岁。中位随访时间为69.5个月。行BCS加RT治疗的患者中，85例pN0(i+)患者的5年和10年局部区域复发（LRR）累积发生率分别为1.6%和3.5%，722例pN0患者分别为2.4%和5%。对于行乳房切除术且未行PMRT的患者，80例pN0(i+)患者的5年和10年LRR率分别为2.8%和2.8%，386例pN0患者分别为1.8%和3%。所有组之间在LRR（p = 0.9）、远处复发（p = 0.3）和总生存（p = 0.5）方面均无统计学显著差异。多因素分析显示，ITC与LRR、远处复发和总生存风险增加无关。分级（p = 0.003）和全身治疗（p = 0.02）与LRR风险在统计学上显著相关。前哨淋巴结ITC对乳腺癌患者的LRR、远处复发和总生存无显著影响。不应仅基于前哨淋巴结ITC的存在而给予腋窝淋巴结清扫术、化疗或区域放疗等额外治疗。
