1Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida.
2Now with Mercy Clinic Breast Surgery - Coletta, Oklahoma City, Oklahoma.
J Natl Compr Canc Netw. 2021 Jan 6;19(1):40-47. doi: 10.6004/jnccn.2020.7597.
Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial supports omission of completion axillary lymph node dissection (CLND) after breast-conservation surgery with a positive sentinel lymph node biopsy (SLNB). We hypothesized that CLND also does not impact outcomes in women with clinically node-negative (cN0), pathologically node-positive breast cancer undergoing mastectomy.
A single-institution retrospective review was performed of patients with SLN-positive breast cancer treated from July 1999 through May 2018. Clinicopathologic and outcome data were collected. Patients with SLNBs were compared with those receiving SLNB and CLND. The Kruskal-Wallis, chi-square, and Fisher exact tests were used to assess for differences between continuous and categorical variables. The log-rank test was used for time-to-event analyses, and Cox proportional hazards models were fit for locoregional and distant recurrence and overall survival (OS).
Of 329 patients with SLN-positive breast cancer undergoing mastectomy, 60% had CLND (n=201). Median age at diagnosis was 53 years (interquartile range [IQR], 46-62 years). The median number of SLNs sampled was 3 (IQR, 2-4), and the median number of positive SLNs was 1 (IQR, 1-2). Patients receiving CLND had higher tumor grades (P=.02) and a higher proportion of hormone receptor negativity (estrogen receptor, 19%; progesterone receptor, 27%; both P=.007). A total of 44 patients (22%) had increased N stage after CLND. Median follow-up was 51 months (IQR, 29-83 months). No association was found between CLND and change in OS and locoregional or distant recurrence. Completion of postmastectomy radiotherapy was associated with improved OS (P=.04).
CLND is not significantly correlated with reduced recurrence or improved OS among patients who have cN0, SLN-positive breast cancer treated with mastectomy. CLND was significantly correlated with receipt of adjuvant systemic therapy. Completion of postmastectomy radiotherapy was associated with improved OS.
美国外科医师学院肿瘤学组（ACOSOG）Z0011 试验的结果支持在保乳手术后，对于前哨淋巴结活检阳性的患者省略完成腋窝淋巴结清扫术（CLND）。我们假设在接受乳房切除术的临床淋巴结阴性（cN0）、病理淋巴结阳性乳腺癌患者中，CLND 也不会影响结局。
对 1999 年 7 月至 2018 年 5 月期间接受前哨淋巴结活检阳性乳腺癌治疗的单机构回顾性研究患者进行了回顾性分析。收集了临床病理和结局数据。比较了仅行前哨淋巴结活检（SLNB）与同时行 SLNB 和 CLND 的患者。采用 Kruskal-Wallis、卡方和 Fisher 确切检验评估连续和分类变量之间的差异。对数秩检验用于评估时间相关事件，Cox 比例风险模型用于评估局部区域和远处复发及总生存（OS）。
329 例接受乳房切除术的前哨淋巴结阳性乳腺癌患者中，60%（n=201）行 CLND。诊断时中位年龄为 53 岁（四分位距[IQR]，46-62 岁）。中位 SLN 取样数为 3 个（IQR，2-4），中位阳性 SLN 数为 1 个（IQR，1-2）。行 CLND 的患者肿瘤分级更高（P=.02），且激素受体阴性的比例更高（雌激素受体，19%；孕激素受体，27%；均 P=.007）。行 CLND 后共有 44 例（22%）患者 N 分期增加。中位随访时间为 51 个月（IQR，29-83 个月）。CLND 与 OS 及局部区域或远处复发的变化无显著相关性。行乳房切除术后放疗与 OS 改善相关（P=.04）。
在接受乳房切除术的 cN0、SLN 阳性乳腺癌患者中，CLND 与降低复发率或改善 OS 无显著相关性。CLND 与接受辅助全身治疗显著相关。行乳房切除术后放疗与 OS 改善相关。
