Department of Surgery, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
Br J Surg. 2020 Sep;107(10):1299-1306. doi: 10.1002/bjs.11610. Epub 2020 Apr 26.
The implementation of screening programmes in Sweden during the mid-1990s increased the number of small node-negative breast cancers. In this era before staging by sentinel node biopsy, routine axillary dissection for staging of early breast cancer was questioned owing to the increased morbidity and lack of perceived benefit. The long-term risk of axillary recurrence when axillary staging is omitted remains unclear.
This prospective observational multicentre cohort study included Swedish women diagnosed with breast cancer between 1997 and 2002. The patients had clinically node-negative, pT1a-b, grade I-II tumours. No axillary staging or dissection was performed. The primary outcome was ipsilateral axillary recurrence and survival.
A total of 1543 patients were included. Breast-conserving surgery (BCS) was performed in 94·0 per cent and the rest underwent mastectomy. After surgery, 58·1 per cent of the women received adjuvant radiotherapy, 11·9 per cent adjuvant endocrine therapy and 31·5 per cent did not receive any adjuvant treatment. After a median follow-up of 15·5 years, 6·4 per cent developed contralateral breast cancer and 16·5 per cent experienced a recurrence. The first recurrence was local in 116, regional in 47 and distant in 59 patients. The breast cancer-specific survival rate was 93·7 per cent after 15 years. There were no differences in overall or breast cancer-specific survival between patients who received adjuvant radiotherapy and those who did not. Only 3·0 per cent of patients had an axillary recurrence, which was isolated in only 1·0 per cent.
Axillary surgery can safely be omitted in patients with low-grade, T1a-b, cN0 breast cancers. This large prospective cohort with 15-year follow-up had a very low incidence of axillary recurrences and high breast cancer-specific survival rate.
20 世纪 90 年代中期，瑞典实施了筛查计划，这导致了小的淋巴结阴性乳腺癌数量的增加。在这个时期，前哨淋巴结活检还没有用于分期，常规的腋窝清扫术用于分期早期乳腺癌，这引起了人们对增加发病率和缺乏益处的质疑。当省略腋窝分期时，长期的腋窝复发风险仍不清楚。
本前瞻性观察性多中心队列研究纳入了 1997 年至 2002 年间在瑞典诊断为乳腺癌的女性患者。这些患者临床淋巴结阴性，pT1a-b，分级 I-II 肿瘤。未进行腋窝分期或清扫。主要结局是同侧腋窝复发和生存。
共纳入 1543 例患者。94.0%的患者行保乳手术（BCS），其余患者行乳房切除术。手术后，58.1%的患者接受了辅助放疗，11.9%的患者接受了辅助内分泌治疗，31.5%的患者未接受任何辅助治疗。中位随访 15.5 年后，6.4%的患者发生对侧乳腺癌，16.5%的患者发生复发。首次复发 116 例为局部复发，47 例为区域复发，59 例为远处复发。15 年后，乳腺癌特异性生存率为 93.7%。接受辅助放疗与未接受辅助放疗的患者在总生存率和乳腺癌特异性生存率方面无差异。仅 3.0%的患者发生腋窝复发，其中仅 1.0%的患者为孤立性腋窝复发。
对于低级别、T1a-b、cN0 乳腺癌患者，可以安全地省略腋窝手术。这项具有 15 年随访的大型前瞻性队列研究，腋窝复发发生率很低，乳腺癌特异性生存率很高。
