Goel Neha, Yadegarynia Sina, Rodgers Steve, Kelly Kristin, Collier Amber, Franceschi Dido, Moller Mecker, Avisar Eli, Kesmodel Susan B
Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
J Surg Oncol. 2021 Jul;124(1):25-32. doi: 10.1002/jso.26480. Epub 2021 Apr 14.
Utilization of sentinel lymph node biopsy (SLNB) in breast cancer patients with positive nodes after neoadjuvant chemotherapy (NAC) has increased. We examine axillary response rates after NAC in patients with clinical N2-3 disease to determine whether SLNB should be considered.
Breast cancer patients with clinical N2-3 (AJCC 7th Edition) disease who received NAC followed by surgery were selected from our institutional tumor registry (2009-2018). Axillary response rates were assessed.
Ninety-nine patients with 100 breast cancers were identified: 59 N2 (59.0%) and 41 (41.0%) N3 disease; 82 (82.0%) treated with axillary lymph node dissection (ALND) and 18 (18.0%) SLNB. The majority (99.0%) received multiagent NAC. In patients undergoing ALND, cCR was observed in 20/82 patients (24.4%), pathologic complete response (pCR) in 15 patients (18.3%), and axillary pCR in 17 patients (20.7%). In patients with a cCR, pCR was identified in 60.0% and was most common in HER2+ patients (34.6%).
In this analysis of patients with clinical N2-3 disease receiving NAC, 79.3% of patients had residual nodal disease at surgery. However, 60.0% of patients with a cCR also had a pCR. This provides the foundation to consider evaluating SLNB and less extensive axillary surgery in this select group.
新辅助化疗（NAC）后淋巴结阳性的乳腺癌患者中前哨淋巴结活检（SLNB）的应用有所增加。我们研究了临床N2-3期疾病患者NAC后的腋窝反应率，以确定是否应考虑进行SLNB。
从我们机构的肿瘤登记处（2009 - 2018年）选取接受NAC后行手术的临床N2-3（美国癌症联合委员会第7版）期疾病的乳腺癌患者。评估腋窝反应率。
共确定99例患者患有100例乳腺癌：59例为N2期（59.0%），41例为N3期（41.0%）；82例（82.0%）接受腋窝淋巴结清扫术（ALND），18例（18.0%）接受SLNB。大多数（99.0%）接受了多药联合NAC。在接受ALND的患者中，20/82例（24.4%）观察到临床完全缓解（cCR），15例（18.3%）达到病理完全缓解（pCR），17例（20.7%）达到腋窝pCR。在cCR患者中，pCR发生率为60.0%，在HER2+患者中最为常见（34.6%）。
在这项对接受NAC的临床N2-3期疾病患者的分析中，79.3%的患者在手术时有残留淋巴结疾病。然而，60.0%的cCR患者也有pCR。这为在这一特定人群中考虑评估SLNB和进行范围较小的腋窝手术提供了依据。
