Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Breast Cancer Res Treat. 2019 Apr;174(3):711-718. doi: 10.1007/s10549-018-05074-y. Epub 2019 Jan 4.
This study aims to evaluate whether extracapsular extension (ECE) in the sentinel lymph node (SLN) is associated with involvement of ≥ 4 lymph node metastases at completion axillary lymph node dissection (ALND) and the effect on 5-year disease-free survival (DFS) and 10-year overall survival (OS). ECE in a SLN is usually a contraindication for omitting completion ALND in cT1-2N0 breast cancer patients treated with breast-conserving therapy and 1-2 positive SLN(s).
All cT1-2N0 breast cancer patients with 1-3 positive SLN(s) who underwent ALND between 2005 and 2008 were selected from the Netherlands Cancer Registry. Logistic regression analysis was used to determine the association between ECE and ≥ 4 lymph node metastases. Five-year DFS and 10-year OS were analyzed using Kaplan-Meier survival analysis. Cox regression analysis was performed to correct for other prognostic factors.
A total of 3502 patients were included. Information on ECE was available for 2111 (60.3%) patients, consisting of 741 (35.1%) patients with and 1370 (64.9%) without ECE. The incidence of ≥ 4 lymph node metastases was 116 (15.7%) in the ECE group vs. 80 (5.8%) in the group without ECE (p < 0.001). Five-year DFS rate was 86.4% in the ECE group compared to 88.8% in the group without ECE (p = 0.085). 10-year OS rate was 78.6% compared to 83.0% (p = 0.018), respectively. Cox regression analysis showed that ECE was not an independent prognostic factor for both DFS and OS.
ECE was significantly associated with involvement of ≥ 4 lymph node metastases in the completion ALND group. ECE was not an independent prognostic factor for both DFS and OS.
本研究旨在评估前哨淋巴结（SLN）中的囊外扩展（ECE）是否与完成腋窝淋巴结清扫术（ALND）时≥4 个淋巴结转移有关，以及对 5 年无病生存率（DFS）和 10 年总生存率（OS）的影响。ECE 在 SLN 中通常是保乳治疗和 1-2 个阳性 SLN(s)的 cT1-2N0 乳腺癌患者省略完成 ALND 的禁忌症。
从荷兰癌症登记处选择了 2005 年至 2008 年间接受 ALND 的所有 cT1-2N0 乳腺癌患者，这些患者的 SLN 中有 1-3 个阳性。Logistic 回归分析用于确定 ECE 与≥4 个淋巴结转移之间的关联。使用 Kaplan-Meier 生存分析分析 5 年 DFS 和 10 年 OS。Cox 回归分析用于校正其他预后因素。
共纳入 3502 例患者。2111 例（60.3%）患者的 ECE 信息可用，其中 741 例（35.1%）患者有 ECE，1370 例（64.9%）患者无 ECE。ECE 组≥4 个淋巴结转移的发生率为 116 例（15.7%），无 ECE 组为 80 例（5.8%）（p<0.001）。ECE 组的 5 年 DFS 率为 86.4%，无 ECE 组为 88.8%（p=0.085）。10 年 OS 率分别为 78.6%和 83.0%（p=0.018）。Cox 回归分析表明，ECE 不是 DFS 和 OS 的独立预后因素。
ECE 与完成 ALND 组中≥4 个淋巴结转移明显相关。ECE 不是 DFS 和 OS 的独立预后因素。
