新辅助化疗后单纯前哨淋巴结活检对乳腺癌的肿瘤学安全性

Oncologic Safety of Sentinel Lymph Node Biopsy Alone After Neoadjuvant Chemotherapy for Breast Cancer.

作者信息

Wong Stephanie M, Basik Mark, Florianova Livia, Margolese Richard, Dumitra Sinziana, Muanza Thierry, Carbonneau Annie, Ferrario Cristiano, Boileau Jean Francois

机构信息

Department of Surgical Oncology, McGill University Medical School, Montreal, QC, Canada.

Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada.

出版信息

Ann Surg Oncol. 2021 May;28(5):2621-2629. doi: 10.1245/s10434-020-09211-0. Epub 2020 Oct 23.

DOI:10.1245/s10434-020-09211-0

PMID:33095362

Abstract

BACKGROUND

The oncologic safety of sentinel lymph node biopsy (SLNB) alone for clinically node-positive (cN1-2) patients who convert to pathologic node-negativity (ypN0) after neoadjuvant chemotherapy (NAC) is not well established.

METHODS

This study retrospectively identified 244 consecutive patients with a diagnosis of cT1-3cN0-2 breast cancer who underwent NAC followed by SLNB at the authors' institution between 2013 and 2018. The patients were categorized as clinically node-negative (cN0) or cN1-2 before the onset of NAC, and the Kaplan-Meier method was used to compare locoregional and distant recurrence rates after SLNB alone for ypN0 patients.

RESULTS

Among 244 patients who underwent NAC followed by surgery with SLNB for axillary staging, 112 (45.9%) were cN0 at presentation, whereas 132 (54.5%) had biopsy-proven cN1-2 disease and converted to cN0 after treatment. Of the patients presenting with cN0 disease, 102 (91.1%) were ypN0 on SLNB pathology compared with 60 cN1/2 patients (45.5%; p < 0.001). Regional nodal irradiation was administered to 5% of the cN0/ypN0 patients compared with 70.7% of the cN1-2/ypN0 patients (p < 0.001). Overall, 211 patients were treated with SLNB alone and had a median follow-up period of 36 months (interquartile range [IQR], 24-53 months). For 101 cN0/ypN0 patients who underwent SLNB alone, the 5-year local and regional recurrence rates were respectively 5.7% (95% confidence interval [CI], 2.4-13.8) and 1% (95% CI 0.1-7.0). For 58 cN1-2/ypN0 patients who underwent SLNB alone, the 5-year local and regional recurrence rates were respectively 4.1% (95% CI 1.0-15.5) and 0%, with no axillary recurrences noted.

CONCLUSION

For ypN0 patients, SLNB alone after NAC is associated with low and acceptable short-term axillary recurrence rates. Additional follow-up data from prospective clinical trials are needed to confirm long-term oncologic safety and define optimal local therapy recommendations.

摘要

背景

对于新辅助化疗（NAC）后转为病理淋巴结阴性（ypN0）的临床淋巴结阳性（cN1-2）患者，单独进行前哨淋巴结活检（SLNB）的肿瘤学安全性尚未明确。

方法

本研究回顾性纳入了2013年至2018年间在作者所在机构接受NAC后行SLNB的244例连续诊断为cT1-3cN0-2乳腺癌的患者。患者在NAC开始前被分类为临床淋巴结阴性（cN0）或cN1-2，采用Kaplan-Meier方法比较ypN0患者单独行SLNB后的局部区域和远处复发率。

结果

在244例接受NAC后行手术及SLNB进行腋窝分期的患者中，112例（45.9%）初诊时为cN0，而132例（54.5%）经活检证实为cN1-2疾病，治疗后转为cN0。初诊为cN0疾病的患者中，102例（91.1%）SLNB病理结果为ypN0，而cN1/2患者中有60例（45.5%）；p<0.001。5%的cN0/ypN0患者接受了区域淋巴结照射，而cN1-2/ypN0患者为70.7%；p<0.001。总体而言，211例患者仅接受了SLNB治疗，中位随访期为36个月（四分位间距[IQR]，24 - 53个月）。对于101例单独行SLNB的cN0/ypN0患者，5年局部和区域复发率分别为5.7%（95%置信区间[CI]，2.4 - 13.8）和1%（95%CI 0.1 - 7.0）。对于58例单独行SLNB的cN1-2/ypN0患者，5年局部和区域复发率分别为4.1%（95%CI 1.0 - 15.5）和0%，未观察到腋窝复发。