Falco Michał, Masojć Bartłomiej, Byrski Tomasz, Kram Andrzej
Radiation Oncology Department, West Pomeranian Oncology Center, Szczecin, Poland.
Department of Oncology, Pomeranian Medical University, Szczecin, Poland.
Asia Pac J Clin Oncol. 2019 Jun;15(3):121-127. doi: 10.1111/ajco.13113. Epub 2019 Feb 13.
Omission of axillary lymph node dissection (ALND) after positive sentinel lymph biopsy (SLNB) has become a standard procedure for breast cancer patients with one or two metastatic lymph nodes. Here the aim was model development for selection for ALND.
We analyzed 323 positive SLNB breast cancer patients, who afterwards underwent ALND. In 126 (39%), there were positive additional axillary lymph nodes. Specimens of resected lymph nodes were scanned and the volumes of tumors (expressed as diameter in mm) were calculated. The maximal diameter of metastasis in the sentinel lymph nodes (SLN ) and axillary lymph nodes (ALN ) indicated tumor load in the resected lymph nodes. ALN higher or equal to 5 mm was defined as high and present in 62 patients (21%).
Risk factors for high ALN were primary tumor diameter (P = 0.0092), histopathological type (P = 0.0173), number of positive SLNs (P = 0.0012), type of metastasis (P = 0.0025), molecular type (P = 0.0037), SLN (P = 0.0001), and Her-2 status (P = 0.0093). Independent variables for high ALN were SLN (P < 0.0001), number of positive SLNs (P = 0.0237) and primary tumor diameter (P = 0.0296).
Twenty-one percent patients with positive SLNB are at risk of high ALN . SLN is the strong predictive factor for high ALN after positive ALND.
前哨淋巴结活检（SLNB）结果为阳性后省略腋窝淋巴结清扫（ALND）已成为有一或两个转移性淋巴结的乳腺癌患者的标准治疗程序。本文旨在开发用于选择是否进行ALND的模型。
我们分析了323例SLNB结果为阳性且随后接受ALND的乳腺癌患者。其中126例（39%）存在额外的腋窝阳性淋巴结。对切除的淋巴结标本进行扫描并计算肿瘤体积（以毫米直径表示）。前哨淋巴结（SLN）和腋窝淋巴结（ALN）中转移灶的最大直径表明切除淋巴结中的肿瘤负荷。ALN直径大于或等于5毫米被定义为高肿瘤负荷，62例患者（21%）存在这种情况。
ALN高肿瘤负荷的危险因素包括原发肿瘤直径（P = 0.0092）、组织病理学类型（P = 0.0173）、阳性SLN数量（P = 0.0012）、转移类型（P = 0.0025）、分子类型（P = 0.0037）、SLN中的转移灶（P = 0.0001）以及Her-2状态（P = 0.0093）。ALN高肿瘤负荷的独立变量为SLN中的转移灶（P < 0.0001）、阳性SLN数量（P = 0.0237）和原发肿瘤直径（P = 0.0296）。
21%的SLNB结果为阳性的患者有ALN高肿瘤负荷的风险。SLN是ALND结果为阳性后ALN高肿瘤负荷的强有力预测因素。
