Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Pharmacology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
J Transl Med. 2018 Nov 19;16(1):318. doi: 10.1186/s12967-018-1692-3.
The diagnosis of metastasis by sentinel lymph node biopsy (SLNB) in early breast cancer surgery provides an accurate view of the state of metastases to the axillary lymph nodes, and it has now become the standard procedure. In the present study, whether omission of axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC) is possible by evaluation of tumor-infiltrating lymphocytes (TILs) before NAC in cases without metastasis on diagnostic imaging, but with metastasis on SLNB, was retrospectively investigated.
A total of 91 patients with resectable, early-stage breast cancer, diagnosed as cT1-2, N0, M0, underwent SLNB and were treated with NAC. A semi-quantitative evaluation of lymphocytes infiltrating the peritumoral stroma as TILs in biopsy specimens of primary tumors prior to treatment was conducted.
In cases with a low number of TILs, estrogen receptor expression was significantly higher (p = 0.044), and human epidermal growth factor receptor 2 (HER2) expression was significantly lower than in other cases (p = 0.019). The number of TILs was significantly lower in cases in which the intrinsic subtype was hormone receptor-positive breast cancer (HRBC) (p = 0.044). Metastasis to axillary lymph nodes was significantly more common in HER2-negative cases and cases with a low number of TILs (p = 0.019, p = 0.005, respectively).
Even if macrometastases are found on SLNB in cN0 patients, it appears that ALND could be avoided after NAC in cases with a good immune tumor microenvironment of the primary tumor.
前哨淋巴结活检（SLNB）在早期乳腺癌手术中的应用为腋窝淋巴结转移状态提供了准确的评估，现已成为标准操作。本研究回顾性探讨了在无远处转移但 SLNB 发现转移的病例中，通过新辅助化疗（NAC）前评估肿瘤浸润淋巴细胞（TILs），是否可以省略腋窝淋巴结清扫（ALND）。
共 91 例可切除的早期乳腺癌患者，cT1-2，N0，M0，接受 SLNB 并接受 NAC。在治疗前对原发肿瘤活检标本中围绕肿瘤的间质中浸润的淋巴细胞进行半定量评估。
在 TIL 数量较少的病例中，雌激素受体表达明显更高（p=0.044），人表皮生长因子受体 2（HER2）表达明显更低（p=0.019）。TIL 数量在激素受体阳性乳腺癌（HRBC）固有亚型中明显较低（p=0.044）。HER2 阴性和 TIL 数量较少的病例中，腋窝淋巴结转移明显更常见（p=0.019，p=0.005）。
即使在 cN0 患者的 SLNB 中发现了大转移灶，在原发性肿瘤具有良好免疫肿瘤微环境的情况下，NAC 后似乎可以避免 ALND。
