Department of Surgical Oncology, Institut Curie, University of Versailles-Saint-Quentin-en-Yvelines, 35 rue Dailly, 92220 Saint-Cloud, France.
Department of Gynaecology-Obstetrics and Reproductive Medicine, Hôpitaux Universitaires Paris-Est, Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
Eur J Surg Oncol. 2015 Jan;41(1):52-8. doi: 10.1016/j.ejso.2014.11.004. Epub 2014 Nov 17.
In patients with breast cancer, the association between the number of sentinel lymph node (SLN) removed and survival is poorly known. Our objective was to evaluate this association on disease-specific survival (DSS).
Data of 144 517 patients with invasive T1-3M0 breast carcinoma and initial treatment with SLN biopsy were extracted from the SEER database. Univariate and multivariate analyses were performed.
The number of SLNs harvested and the completion of axillary lymph node dissection (ALND) were not associated with DSS improvement for patients without metastatic nodes. After adjustment, patients with three SLNs had a better DSS than did other groups (HR of 0.73 CI 95% [0.60-0.88], p = 0.001). This result was mainly driven by the group of patients with one metastatic LN. When patients had two or more metastatic LNs, there was no difference in DSS according to the number of SLNs or to completion of ALND.
The number of SLN harvested was associated with DSS. According to DSS, the optimal number of SLNs harvested was three in this large series, thereby calling into question the understaging or undertreatment of SLN biopsy in which only one or two SLNs are harvested but also the therapeutic effect of completion ALND.
在乳腺癌患者中，前哨淋巴结（SLN）切除数量与生存之间的关系尚不清楚。我们的目的是评估其与疾病特异性生存（DSS）的关系。
从 SEER 数据库中提取了 144517 例浸润性 T1-3M0 乳腺癌患者的初始 SLN 活检治疗数据。进行了单因素和多因素分析。
对于无转移淋巴结的患者，SLN 采集数量和腋窝淋巴结清扫术（ALND）的完成与 DSS 改善无关。调整后，与其他组相比，有 3 个 SLN 的患者 DSS 更好（HR 95%CI [0.60-0.88]，p=0.001）。这一结果主要归因于有 1 个转移淋巴结的患者群体。当患者有 2 个或更多转移淋巴结时，根据 SLN 数量或 ALND 的完成情况，DSS 没有差异。
采集的 SLN 数量与 DSS 相关。根据 DSS，在这项大型研究中，最佳的 SLN 采集数量为 3 个，这使得对仅采集 1 个或 2 个 SLN 的 SLN 活检的低估或治疗不足以及完成 ALND 的治疗效果产生了质疑。
