Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Ann Surg. 2018 Dec;268(6):1084-1090. doi: 10.1097/SLA.0000000000002440.
To evaluate patterns of care in axillary surgery for Dutch clinical T1-4N0M0 (cT1-4N0M0) breast cancer patients and to assess the effect of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trial on axillary surgery patterns in Dutch cT1-2N0M0 sentinel node positive breast cancer patients.
Since publication of the ACOSOG-Z0011 and AMAROS trial, omitting a completion axillary lymph node dissection (cALND) in sentinel node positive breast cancer patients is proposed in selected patients.
Data were obtained from the nationwide Nationaal Borstkanker Overleg Nederland breast cancer audit. Descriptive analyses were used to demonstrate trends in axillary surgery. Multivariable logistic regression analyses were used to identify factors associated with the omission of cALND in cT1-2N0M0 sentinel node-positive breast cancer patients.
Between 2011 and 2015 in cT1-4N0M0 breast cancer patients, the use of sentinel lymph node biopsy as definitive axillary staging increased from 72% to 93%, and (c)ALND as definitive axillary staging decreased from 24% to 6% (P < 0.001). The use of cALND decreased from 75% to 17% in cT1-2N0 sentinel node-positive patients (P < 0.001). Earlier year of diagnosis, lower age, primary mastectomy, invasive lobular subtype, increasing tumor grade, and treatment in a nonteaching hospital were associated with a lower probability of omitting cALND (P < 0.001).
This study shows a trend towards less extensive axillary surgery in Dutch cT1-T4N0M0 breast cancer patients; illustrated by an overall increase of sentinel lymph node biopsy and decrease in cALND. Despite this trend, particularly noticed in cT1-2N0 sentinel node-positive patients after publication of the ACOSOG-Z0011 and AMAROS trial, variations in patterns of care in axillary surgery are still present.
评估荷兰临床 T1-4N0M0（cT1-4N0M0）乳腺癌患者腋窝手术的治疗模式，并评估美国外科医师学院肿瘤学组（ACOSOG）-Z0011 和腋窝后映射：放疗或手术（AMAROS）试验对荷兰 cT1-2N0M0 前哨淋巴结阳性乳腺癌患者腋窝手术模式的影响。
自 ACOSOG-Z0011 和 AMAROS 试验发表以来，建议在某些患者中省略前哨淋巴结阳性乳腺癌患者的完全腋窝淋巴结清扫术（cALND）。
数据来自全国性的荷兰乳腺癌咨询全国乳腺癌监测。描述性分析用于显示腋窝手术的趋势。多变量逻辑回归分析用于确定与 cT1-2N0M0 前哨淋巴结阳性乳腺癌患者省略 cALND 相关的因素。
在 2011 年至 2015 年的 cT1-4N0M0 乳腺癌患者中，作为明确腋窝分期的前哨淋巴结活检的使用率从 72%增加到 93%，而作为明确腋窝分期的（c）ALND 的使用率从 24%减少到 6%（P<0.001）。在 cT1-2N0 前哨淋巴结阳性患者中，cALND 的使用率从 75%下降到 17%（P<0.001）。较早的诊断年份、较低的年龄、原发性乳房切除术、浸润性小叶癌亚型、肿瘤分级增加以及在非教学医院治疗与较低的 cALND 省略概率相关（P<0.001）。
本研究表明，荷兰 cT1-T4N0M0 乳腺癌患者的腋窝手术范围呈缩小趋势；这一趋势表现为前哨淋巴结活检的总体增加和 cALND 的减少。尽管存在这一趋势，特别是在 ACOSOG-Z0011 和 AMAROS 试验发表后在 cT1-2N0 前哨淋巴结阳性患者中观察到，但腋窝手术治疗模式仍存在差异。
