Gondos Adam, Jansen Lina, Heil Jörg, Schneeweiss Andreas, Voogd Adri C, Frisell Jan, Fredriksson Irma, Johansson Ulla, Tvedskov Tove Filtenborg, Jensen Maj-Britt, Balslev Eva, Hartmann-Johnsen Olaf Johan, Sant Milena, Baili Paolo, Agresti Roberto, van de Velde Tony, Broeks Annegien, Nogaret Jean-Marie, Bourgeois Pierre, Moreau Michel, Mátrai Zoltán, Sávolt Ákos, Nagy Péter, Kásler Miklós, Schrotz-King Petra, Ulrich Cornelia, Brenner Hermann
a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany ;
b Breast Unit , Women Hospital, National Center of Tumor Diseases, University Hospital, University of Heidelberg , Heidelberg , Germany ;
Acta Oncol. 2016 Jun;55(6):712-9. doi: 10.3109/0284186X.2015.1136751. Epub 2016 Feb 15.
Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79-96% and 49-92% for pT1 and pT2 tumors, respectively. Axillary lymph node dissection (ALND) use for pT1 tumors decreased from between 75% and 27% in 2003 to 47% and 12% in 2010, and from between 90% and 55% to 79% and 19% for pT2 tumors, respectively. In 2014, important differences in axillary management existed for patients with micrometastases only, and for patients fulfilling the ACOSOG Z0011 criteria for omitting ALND. Conclusion This study demonstrates persisting differences in important aspects of axillary management throughout the recent decade. The results highlight the need for international comparative patterns of care studies in oncology, which may help to identify areas where further studies and consensus building may be necessary.
背景 我们研究了欧洲临床环境中早期乳腺癌患者腋窝管理的时间趋势。
材料与方法 EUROCANPlatform合作伙伴，包括基于人群的登记处和癌症中心特定登记处，提供了常规可用的临床癌症登记数据，用于比较过去十年中未接受新辅助治疗的首次非转移性乳腺癌患者的腋窝管理趋势。我们使用了一份额外的简短问卷来比较2014年的临床护理模式。
结果 在癌症中心接受治疗的患者比基于人群的登记人群年轻。不同环境或不同时间的肿瘤大小和淋巴结状态分布变化不大。2003年，pT1肿瘤前哨淋巴结活检（SLNB）的使用率在26%至81%之间，pT2肿瘤的使用率在2%至68%之间。到2010年，pT1和pT2肿瘤的SLNB使用率分别增至79 - 96%和49 - 92%。pT1肿瘤腋窝淋巴结清扫（ALND）的使用率从2003年的75%至27%降至2010年的47%和12%，pT2肿瘤的使用率从90%至55%降至79%和19%。2014年，仅微转移患者以及符合ACOSOG Z0011标准可省略ALND的患者在腋窝管理方面存在重要差异。
结论 本研究表明在最近十年中腋窝管理的重要方面持续存在差异。结果强调了肿瘤学中开展国际护理模式比较研究的必要性，这可能有助于确定哪些领域需要进一步研究并达成共识。
