Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Oct;28(11):6044-6050. doi: 10.1245/s10434-021-09910-2. Epub 2021 Apr 19.
In patients with a positive sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC), the likelihood of residual nodal disease at axillary dissection (ALND) is high. Whether non-SLN metastasis frequency varies based on tumor subtype and SLN metastasis size is uncertain. We examined the association between tumor subtype and frequency of non-SLN metastases in patients with SLN micro- vs macrometastases after NAC.
Patients with invasive breast cancer and a positive SLN biopsy after NAC between July 2008 and July 2019 were identified. Associations between tumor subtype, SLN disease volume, and frequency of non-SLN metastases were examined.
Among 273 patients with ≥ 1 positive SLN and a completion ALND, mean age was 51 years, 87% of tumors were ductal, 80% were clinically node-positive at presentation, and 85% were cT2-3. The frequency of non-SLN metastases was non-significantly higher in HR+/HER2- (61%) vs. HER2+ (52%) and triple negative tumors (45%) (p = 0.09). Frequency of SLN micrometastasis was 9% for triple negative tumors compared with 17% for HR+/HER2- and 34% for HER2+ tumors (p = 0.015). Size of SLN metastasis (micro- vs. macrometastases) was not associated with non-SLN metastasis frequency or number within any subtype.
In patients with a positive SLN after NAC, the likelihood of non-SLN metastasis at ALND was high across all tumor subtypes and did not vary significantly for SLN micro- versus macrometastases. ALND is recommended for SLN micro- and macrometastases after NAC, irrespective of tumor subtype.
新辅助化疗（NAC）后，前哨淋巴结（SLN）阳性患者行腋窝清扫术（ALND）时，腋窝内存在残留淋巴结疾病的可能性较高。但肿瘤亚型和 SLN 转移灶大小是否与非 SLN 转移频率相关尚不确定。我们检测了新辅助化疗后 SLN 微转移和宏转移患者的肿瘤亚型与非 SLN 转移频率之间的关系。
本研究纳入了 2008 年 7 月至 2019 年 7 月间，接受 NAC 后 SLN 活检阳性的浸润性乳腺癌患者。分析了肿瘤亚型、SLN 疾病体积与非 SLN 转移频率之间的关系。
273 例至少有 1 个 SLN 阳性并完成 ALND 的患者中，平均年龄为 51 岁，87%的肿瘤为导管癌，80%的患者在就诊时临床淋巴结阳性，85%的患者为 cT2-3。HR+/HER2-（61%）和 HER2+（52%）肿瘤的非 SLN 转移频率高于三阴性肿瘤（45%），但差异无统计学意义（p = 0.09）。三阴性肿瘤 SLN 微转移的频率为 9%，而 HR+/HER2-和 HER2+肿瘤的 SLN 微转移频率分别为 17%和 34%（p = 0.015）。SLN 转移灶大小（微转移与宏转移）与任何亚型的非 SLN 转移频率或数量均无关。
NAC 后 SLN 阳性的患者，所有肿瘤亚型在 ALND 时非 SLN 转移的可能性均较高，SLN 微转移与宏转移之间无显著差异。因此，无论肿瘤亚型如何，均推荐对 NAC 后 SLN 微转移和宏转移行 ALND。
