García-Novoa Alejandra, Acea-Nebril Benigno, Casal-Beloy Isabel, Bouzón-Alejandro Alberto, Cereijo Garea Carmen, Gómez-Dovigo Alba, Builes-Ramírez Sergio, Santiago Paz, Mosquera-Oses Joaquín
Unidad de Mama, Complejo Hospitalario Universitario de A Coruña, A Coruña, España.
Unidad de Mama, Complejo Hospitalario Universitario de A Coruña, A Coruña, España.
Cir Esp (Engl Ed). 2019 Apr;97(4):222-229. doi: 10.1016/j.ciresp.2019.01.010. Epub 2019 Mar 8.
In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital.
A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection.
1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years.
The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival.
在过去20年中，乳腺癌的淋巴结分期程序已经改变。本研究的目的是描述我院这些程序的演变。
一项前瞻性观察性研究，纳入了2001年至2017年间接受手术治疗的乳腺癌女性患者。根据治疗方案确定了四组，并根据淋巴结清扫定义了3个研究时期。
1319例患者符合纳入标准。保乳手术是最常用的治疗方法（54.13%），在20年的研究期间共进行了615例（46.62%）腋窝淋巴结清扫术（ALND）。ALND的百分比随时间逐渐下降，从第一阶段的91%降至最后阶段的34%。无效的ALND在最后一年降至6.6%。在保乳手术中，过去两年未进行无效的ALND。
前哨淋巴结活检的引入和美国外科医师学会肿瘤学组（ACOSOG）Z0011标准改变了ALND的适应证。因此，未受累的ALND减少，从而避免了相关的发病率。该研究表明，不同研究组中淋巴结清扫术的适应证逐渐减少，这与其他作者的报道相似。几项临床试验表明，这些改变并未对生存率产生负面影响。
