Grova Monica M, Strassle Paula D, Navajas Emma E, Gallagher Kristalyn K, Ollila David W, Downs-Canner Stephanie M, Spanheimer Philip M
Department of Surgery, Surgical Oncology and Endocrine Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Ann Surg Oncol. 2021 Apr;28(4):2182-2190. doi: 10.1245/s10434-020-09152-8. Epub 2020 Sep 24.
Inflammatory breast cancer (IBC) has historically been characterized by high rates of recurrence and poor survival; however, there have been significant improvements in systemic therapy. We sought to investigate modern treatment of IBC and define the yield and prognostic significance of axillary lymph nodes after neoadjuvant chemotherapy (NAC).
Women with clinical stage T4d, N0-N3, M0 IBC from 2012 to 2016 in the National Cancer Database were included. Kaplan-Meier survival curves and Cox regression were used to assess mortality by receptor subtype and nodal status.
We identified 5265 patients; 37% hormone receptor (HR) +/HER2 - , 19% HR +/HER2 + , 18% HR -/HER2 + , and 26% triple-negative, and 5-year overall survival was 51.6%. Only 34% were treated according to guidelines with NAC, modified radical mastectomy, and adjuvant radiation. Pathologically positive lymph nodes (ypN +) after NAC varied by subtype and clinical nodal status (cN) ranging from 82% in cN + HR +/HER2 - patients to 19% in cN0 HR -/HER2 + patients. ypN + strongly correlated with survival in all subtypes with the most pronounced impact in HR +/HER2 + patients, with 90% 5-year overall survival in ypN0 versus 66% for ypN + (HR 4.29, 95% CI 1.58-11.70, p = 0.03).
Five-year survival in M0 IBC is 51.6%. Positive nodes after NAC varied by subtype and clinical N status but is sufficiently high and provided meaningful prognostication in all subtypes to support continued routine pathologic assessment. Future study is warranted to identify reliable, less morbid, methods of staging the axilla in IBC patients appropriate for deescalation of axillary surgery.
炎性乳腺癌（IBC）历来具有高复发率和低生存率的特点；然而，全身治疗已取得显著进展。我们试图研究IBC的现代治疗方法，并确定新辅助化疗（NAC）后腋窝淋巴结的检出率及其预后意义。
纳入2012年至2016年国家癌症数据库中临床分期为T4d、N0-N3、M0的IBC女性患者。采用Kaplan-Meier生存曲线和Cox回归分析按受体亚型和淋巴结状态评估死亡率。
我们共纳入5265例患者；其中37%为激素受体（HR）阳性/人表皮生长因子受体2（HER2）阴性，19%为HR阳性/HER2阳性，18%为HR阴性/HER2阳性，26%为三阴性，5年总生存率为51.6%。只有34%的患者按照指南接受了NAC、改良根治性乳房切除术和辅助放疗。NAC后病理阳性淋巴结（ypN+）因亚型和临床淋巴结状态（cN）而异，范围从cN+ HR阳性/HER2阴性患者中的82%到cN0 HR阴性/HER2阳性患者中的19%。ypN+与所有亚型的生存率密切相关，对HR阳性/HER2阳性患者影响最为显著，ypN0患者的5年总生存率为90%，而ypN+患者为66%（风险比4.29，95%置信区间1.58-11.70，p=0.03）。
M0期IBC患者的5年生存率为51.6%。NAC后阳性淋巴结因亚型和临床N状态而异，但比例足够高，且在所有亚型中均提供了有意义的预后信息，以支持继续进行常规病理评估。有必要开展进一步研究，以确定适用于IBC患者腋窝手术降阶梯治疗的可靠且创伤较小的腋窝分期方法。
