Peg Vicente, Sansano Irene, Vieites Begoña, Bernet Laia, Cano Rafael, Córdoba Alicia, Sancho Magdalena, Martín María Dolores, Vilardell Felip, Cazorla Alicia, Espinosa-Bravo Martín, Pérez-García José Manuel, Cortés Javier, Rubio Isabel T, Ramón Y Cajal Santiago
Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Morphological Sciences Department, Universidad Autónoma de Barcelona, Spain.
Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Morphological Sciences Department, Universidad Autónoma de Barcelona, Spain.
Breast. 2017 Jun;33:8-13. doi: 10.1016/j.breast.2017.02.011. Epub 2017 Feb 28.
Axillary staging (pN) is considered one of the most important prognostic factors in breast cancer patients. However, the Z0011 study data drastically reduced the number of surgical axillary dissections in a selected group of patients, limiting the prognostic information relating to axillary involvement to the sentinel lymph node (SLN). It is known that there is a relationship between SLN total tumour load (TTL) and axillary involvement. The objective of this study is to analyse the relationship between the TTL and outcomes in patients with early stage breast cancer.
clinicopathological and follow-up data were collected from 950 patients with breast cancer between 2009 and 2010 on whom SLN analysis was conducted by molecular methods (One Step Nucleic Acid Amplification, Sysmex, Kobe, Japan).
TTL (defined as the total number of CK19 mRNA copies in all positive SLN) correlates with disease free survival (HR, 1.08; p = 0.000004), with local recurrence disease free survival (HR = 1.07; p = 0.0014) and overall survival (HR: 1.08, p = 0.0032), clearly defining a low-risk group (TTL <2.5 × 10 CK19 mRNA copies/μL) versus a high-risk group (>2.5 × 10 CK 19 mRNA copies/μL).
SLN TTL permits the differentiation between two patient groups in terms of DFS and OS, independently of axillary staging (pN), age and tumour characteristics (size, grade, lymphovascular invasion). This new data confirms the clinical value of low axillary involvement and could partially replace the information that staging of the entire axilla provides in patients on whom no axillary lymph node dissection is performed.
腋窝分期（pN）被认为是乳腺癌患者最重要的预后因素之一。然而，Z0011研究数据大幅减少了特定患者群体的腋窝手术清扫数量，将与腋窝受累相关的预后信息限制在前哨淋巴结（SLN）。已知SLN总肿瘤负荷（TTL）与腋窝受累之间存在关联。本研究的目的是分析早期乳腺癌患者的TTL与预后之间的关系。
收集了2009年至2010年间950例乳腺癌患者的临床病理和随访数据，这些患者通过分子方法（一步核酸扩增，Sysmex，日本神户）进行了SLN分析。
TTL（定义为所有阳性SLN中CK19 mRNA拷贝总数）与无病生存期（HR，1.08；p = 0.000004）、局部复发无病生存期（HR = 1.07；p = 0.0014）和总生存期（HR：1.08，p = 0.0032）相关，明确区分了低风险组（TTL <2.5×10 CK19 mRNA拷贝/μL）和高风险组（>2.5×10 CK19 mRNA拷贝/μL）。
SLN TTL能够在DFS和OS方面区分两组患者，独立于腋窝分期（pN）、年龄和肿瘤特征（大小、分级、淋巴管侵犯）。这一新数据证实了低腋窝受累的临床价值，并可部分替代在未进行腋窝淋巴结清扫的患者中整个腋窝分期所提供的信息。
