Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure City, Hiroshima, 737-0023, Japan.
Department of Medical Oncology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure City, Hiroshima, Japan.
World J Surg Oncol. 2019 Feb 23;17(1):41. doi: 10.1186/s12957-019-1585-9.
The prognostic value of sentinel lymph node (SLN) metastases may be minimized by the limited disease burden of lymph node metastases and tailoring adjuvant therapy based on breast cancer biology. The aim of this study is to assess the prognostic significance of SLN metastasis in patients with cT1-2N0M0 breast cancer.
Between January 2006 and December 2015, 582 patients underwent SLN biopsy for cT1-2N0M0 breast cancers. cN0 was essentially diagnosed by ultrasound sonography. The prognostic values of SLN metastases were retrospectively evaluated.
Among 582 patients with cT1-2N0M0 breast cancer, 111 patients (19.1%) were positive for SLN metastasis, including 39 cases (6.7%) of micrometastasis and 72 cases (12.4%) of macrometastases. The median size of SLN metastasis was 3.0 mm (range 0.2-16 mm, mean 4.1 mm). In log-rank test, presence of SLN metastasis was not associated with breast cancer recurrence (p = 0.21); 5-year and 10-year recurrence-free survival (RFS) were 93.0% and 96.5%, and 93.0% and 90.4% in the SLN-positive and SLN-negative groups, respectively. In the propensity score matching cohort (n = 178), there was no significant difference in RFS between the SLN-positive and SLN-negative groups (p = 0.90). In Cox regression analysis, a continuous value of Ki67 expression was a significant prognostic factor (HR 1.03; 95% CI 1.01-1.05, p = 0.017).
SLN metastasis has a minimal impact on RFS for patients with cT1-2N0M0 breast cancer in the modern medical era. A proliferation marker is a better factor for poor prognosis than the presence of SLN metastases in this population.
由于淋巴结转移的疾病负担有限，并且可以根据乳腺癌生物学特征进行辅助治疗的调整，因此前哨淋巴结（SLN）转移的预后价值可能会降低。本研究旨在评估 SLN 转移对 cT1-2N0M0 乳腺癌患者的预后意义。
2006 年 1 月至 2015 年 12 月，582 例 cT1-2N0M0 乳腺癌患者接受 SLN 活检。cN0 主要通过超声检查诊断。回顾性评估 SLN 转移的预后价值。
在 582 例 cT1-2N0M0 乳腺癌患者中，111 例（19.1%）SLN 转移阳性，其中 39 例（6.7%）为微转移，72 例（12.4%）为宏转移。SLN 转移的中位大小为 3.0mm（范围 0.2-16mm，平均 4.1mm）。在对数秩检验中，SLN 转移与乳腺癌复发无关（p=0.21）；5 年和 10 年无复发生存率（RFS）分别为 93.0%和 96.5%，SLN 阳性和 SLN 阴性组分别为 93.0%和 90.4%。在倾向评分匹配队列（n=178）中，SLN 阳性和 SLN 阴性组的 RFS 无显著差异（p=0.90）。在 Cox 回归分析中，Ki67 表达的连续值是一个显著的预后因素（HR 1.03；95%CI 1.01-1.05，p=0.017）。
在现代医学时代，SLN 转移对 cT1-2N0M0 乳腺癌患者的 RFS 影响很小。在该人群中，增殖标志物是比 SLN 转移更差的预后因素。
