Bhargavan R V, Mirza A, Cherian K, Krishna J, Augustine P
Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
Ann R Coll Surg Engl. 2020 Mar;102(3):214-219. doi: 10.1308/rcsann.2019.0142. Epub 2019 Nov 22.
Breast cancer is the most common female cancer in India, and 30-60% of patients present with locally advanced breast cancer. Level III clearance is routinely performed in India in locally advanced breast cancer following neoadjuvant chemotherapy, even in clinical complete response. We analysed our data of patients with locally advanced breast cancer post-neoadjuvant chemotherapy who have undergone level III clearance to identify any subgroup in which level III dissection can be avoided.
This is a retrospective study of female patients with locally advanced breast cancer who received neoadjuvant chemotherapy and underwent breast surgery including level III nodal clearance between June 2016 and May 2018. Data collected included age, menopausal status, TNM stage at presentation, grade, estrogen, progesterone, human epidermal growth factor receptor 2 status, response to treatment, post-chemotherapy stage and final histopathology. Uni- and multivariate analysis was undertaken.
Data from 200 patients was analysed. The level III positivity rate was 15.5%. The clinical complete response rate was 43%, of which 41% had pathological complete response. A significant association was present between level III node positivity and pathological T stage (=0.03). No association was seen between level III positivity and any other studied variables. In the subset of patients with cT3N1 and cT2N2, level III positivity was seen in only 3/49 (6.1%) and 1/31 (3%), respectively.
Level III positivity rate is high and so cannot be avoided in locally advanced breast cancer following neoadjuvant chemotherapy. None of the preoperative factors predict for level III positivity. Level III positivity in cT3N1 and cT2N2 is low and these subgroups require further studies.
乳腺癌是印度最常见的女性癌症，30%-60%的患者表现为局部晚期乳腺癌。在印度，新辅助化疗后，即使临床完全缓解，局部晚期乳腺癌患者也常规进行Ⅲ级清扫。我们分析了新辅助化疗后接受Ⅲ级清扫的局部晚期乳腺癌患者的数据，以确定是否存在可避免Ⅲ级清扫的亚组。
这是一项对2016年6月至2018年5月期间接受新辅助化疗并接受包括Ⅲ级淋巴结清扫在内的乳腺手术的局部晚期乳腺癌女性患者的回顾性研究。收集的数据包括年龄、绝经状态、初诊时的TNM分期、分级、雌激素、孕激素、人表皮生长因子受体2状态、治疗反应、化疗后分期和最终组织病理学。进行了单因素和多因素分析。
分析了200例患者的数据。Ⅲ级阳性率为15.5%。临床完全缓解率为43%，其中41%为病理完全缓解。Ⅲ级淋巴结阳性与病理T分期之间存在显著相关性（=0.03）。未发现Ⅲ级阳性与任何其他研究变量之间存在相关性。在cT3N1和cT2N2患者亚组中，Ⅲ级阳性率分别仅为3/49（6.1%）和1/31（3%）。
新辅助化疗后局部晚期乳腺癌的Ⅲ级阳性率较高，因此无法避免。术前没有任何因素可预测Ⅲ级阳性。cT3N1和cT2N2中的Ⅲ级阳性率较低，这些亚组需要进一步研究。
