Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
Department of Surgery, Deaconesses Hospital, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
Eur J Surg Oncol. 2018 Aug;44(8):1151-1156. doi: 10.1016/j.ejso.2018.03.003. Epub 2018 Mar 14.
The ACOSOG-Z0011-study has resulted in a trend to a more conservative treatment of the axilla for selected sentinel-node-positive patients. However, axillary nodal involvement has always been an important factor for tumor staging and tailoring adjuvant chemotherapy plans. This study evaluates the impact of omitting completion axillary lymph node dissection (cALND) on the administration of adjuvant chemo (-immuno)therapy in Dutch clinical T1-2N0M0 (cT1-2N0M0) sentinel-node-positive breast cancer patients.
Data were obtained from the nationwide NABON breast cancer audit. Descriptive analyses were used to demonstrate trends in axillary surgery and adjuvant chemo (-immuno)therapy. Multivariable logistic regression analyses were used to identify factors associated with the prescription of chemo (-immuno)therapy.
In this cohort of 4331 patients, the omission of a cALND increased from 34% to 92%, and the administration of chemo (-immuno)therapy decreased from 68% to 55%, between 2011 and 2015 (P < 0.001). Patients treated with cALND had an OR of 2.2 for receiving adjuvant chemo (-immuno)therapy compared with SLNB only patients. Lower age, a hormone receptor (HR) status other than HR-positive, HER2-negative, increasing tumor grade and stage, and a lymph node status ≥ pN2 were independently associated with a higher probability of chemo (-immuno)therapy (P < 0.05).
This study showed that Dutch cT1-2N0M0 sentinel node-positive breast cancer patients treated with cALND had a higher independent probability for receiving adjuvant chemo (-immuno)therapy compared with SLNB only patients, even when corrected for lymph node status and HR-status. Probably, the decisions to administer adjuvant chemo (-immuno)therapy were not only based on guidelines and tumor characteristics, but also on the preferences from physicians and patients.
ACOSOG-Z0011 研究导致了一种趋势，即对于某些前哨淋巴结阳性患者，更倾向于采用更保守的腋窝治疗方法。然而，腋窝淋巴结受累一直是肿瘤分期和制定辅助化疗方案的重要因素。本研究评估了省略完成腋窝淋巴结清扫术（cALND）对荷兰临床 T1-2N0M0（cT1-2N0M0）前哨淋巴结阳性乳腺癌患者辅助化疗（-免疫）治疗的影响。
数据来自全国 NABON 乳腺癌审计。描述性分析用于展示腋窝手术和辅助化疗（-免疫）治疗的趋势。多变量逻辑回归分析用于确定与化疗（-免疫）治疗处方相关的因素。
在这个队列中，4331 名患者中，cALND 的省略率从 2011 年到 2015 年从 34%增加到 92%，而化疗（-免疫）治疗的应用率从 68%下降到 55%（P<0.001）。与仅行 SLNB 患者相比，行 cALND 的患者接受辅助化疗（-免疫）治疗的 OR 为 2.2。较低的年龄、激素受体（HR）状态不是 HR 阳性、HER2 阴性、肿瘤分级和分期增加以及淋巴结状态≥pN2 与更高的化疗（-免疫）治疗概率独立相关（P<0.05）。
本研究表明，与仅行 SLNB 患者相比，荷兰 cT1-2N0M0 前哨淋巴结阳性乳腺癌患者行 cALND 治疗的患者接受辅助化疗（-免疫）治疗的概率更高，即使校正了淋巴结状态和 HR 状态。可能，辅助化疗（-免疫）治疗的决策不仅基于指南和肿瘤特征，还基于医生和患者的偏好。
