Jung Jiwoong, Kim Byoung Hyuck, Kim Jongjin, Oh Sohee, Kim Su-Jin, Lim Chang-Sup, Choi In Sil, Hwang Ki-Tae
Department of Surgery, Seoul Medical Center, Seoul 02053, Korea.
Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea.
Cancers (Basel). 2020 Apr 11;12(4):950. doi: 10.3390/cancers12040950.
The Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be omitted in spite of 1-2 metastatic sentinel lymph nodes. This study aimed to validate the results on a population-based database. The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients comparable to the Z0011 participants. The type of axillary surgery was estimated using the total number of examined axillary lymph nodes (ALNs). Breast cancer-specific mortality (BCSM) was compared between patients with ≥10 ALNs (the sentinel lymph node dissection (SLND) and ALND group, or "SLND + ALND group") and patients with one or two ALNs (the "SLND group"). During 2010-2015, the SEER database included 7077 and 6620 patients categorized in the SLND group and the SLND + ALND group, respectively. Death was observed for 515 patients (7.3%) in the SLND group and 589 patients (8.9%) in the SLND + ALND group based on a median follow-up of 41 months. After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group (vs. the SLND + ALND group) was 1.038 (95% confidence interval: 0.798-1.350). Regardless of the SLND criteria, the outcomes were not significantly different between the two groups. This retrospective cohort study of Z0011-comparable patients revealed that ALND could be omitted based on the Z0011 strategy, even among patients with ≤2 dissected ALNs.
Z0011试验表明，尽管有1 - 2枚前哨淋巴结转移，腋窝淋巴结清扫术（ALND）仍可省略。本研究旨在基于一个人群数据库验证该结果。在监测、流行病学和最终结果（SEER）数据库中搜索与Z0011试验参与者相似的患者。使用检查的腋窝淋巴结（ALN）总数来估计腋窝手术类型。比较有≥10枚ALN的患者（前哨淋巴结活检术（SLND）和ALND组，即“SLND + ALND组”）和有1枚或2枚ALN的患者（“SLND组”）的乳腺癌特异性死亡率（BCSM）。在2010 - 2015年期间，SEER数据库分别纳入了7077例和6620例分类在SLND组和SLND + ALND组的患者。基于41个月的中位随访，SLND组有515例患者（7.3%）死亡，SLND + ALND组有589例患者（8.9%）死亡。倾向得分匹配后，SLND组（与SLND + ALND组相比）BCSM的调整后风险比为1.038（95%置信区间：0.798 - 1.350）。无论SLND标准如何，两组之间的结果无显著差异。这项针对与Z0011试验相似患者的回顾性队列研究表明，即使在切除的ALN≤2枚的患者中，根据Z0011策略也可省略ALND。
