Breast Unit, Cancer Center, IRCCS Clinical Institute Humanitas, Rozzano (MI), Italy.
Anatomia Patologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Eur J Surg Oncol. 2021 Aug;47(8):1920-1927. doi: 10.1016/j.ejso.2021.04.039. Epub 2021 May 3.
Whether the extent of residual disease in the sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC) influences the prognosis in clinically node-positive breast cancer (BC) patients remains to be ascertained.
One hundred and thirty-four consecutive cN+/BC-patients received NAC followed by SLN biopsy and axillary lymph node dissection. Cumulative incidence of overall (OS) and disease-free (DFS) survival, BC-related recurrences and death from BC were assessed using the Kaplan-Meier method both in the whole patient population and according to the SLN status. The log rank test was used for comparisons between groups.
The SLN was identified in 123/134 (91.8%) patients and was positive in 98/123 (79.7%) patients. Sixty-five of them (66.3%) had other axillary nodes involved. SLN sensitivity and false-negative rate were 88.0% and 2.0%, Median follow-up was 10.2 years. Ten-year cumulative incidence of axillary, breast and distant recurrences, and death from BC were 6.5%, 11.9%, 33.4% and 31.3%, respectively. Ten-year OS and DFS were 67.3% and 55.9%. When stratified by SLN status, 10-year cumulative incidence of BC-related and loco-regional events, and death from BC were similar between disease-free SLN and micrometastatic SLN subgroups (28.9% vs 30.2%, p = 0.954; 21.6% vs 13.4%, p = 0.840; 12.9 vs 24.5%, p=0.494). Likewise, 10-year OS and DFS were comparable (80.0% vs 75.5%, p=0.975 and 68.0% vs 69.8, p=0.836). Both OS and DFS were lower in patients presenting a macrometastatic SLN (60.2% and 47.5%).
Outcome of patients with micrometastatic SLN was similar to that of patients with disease-free SLN, which was more favorable as compared to that of patients with macrometastatic SLN.
新辅助化疗（NAC）后前哨淋巴结（SLN）中的残留疾病程度是否会影响临床淋巴结阳性乳腺癌（BC）患者的预后仍有待确定。
134 例连续的 cN+/BC-患者接受 NAC 治疗，随后进行 SLN 活检和腋窝淋巴结清扫。使用 Kaplan-Meier 方法评估整体（OS）和无病（DFS）生存、BC 相关复发和 BC 死亡的累积发生率，同时在整个患者人群中以及根据 SLN 状态进行比较。对数秩检验用于组间比较。
134 例患者中有 123 例（91.8%）识别出 SLN，123 例中有 98 例（79.7%）为阳性。其中 65 例（66.3%）有其他腋窝淋巴结受累。SLN 的灵敏度和假阴性率分别为 88.0%和 2.0%，中位随访时间为 10.2 年。10 年累积的腋窝、乳腺和远处复发以及 BC 死亡的发生率分别为 6.5%、11.9%、33.4%和 31.3%。10 年 OS 和 DFS 分别为 67.3%和 55.9%。按 SLN 状态分层，无疾病 SLN 和微转移 SLN 亚组的 BC 相关和局部区域事件以及 BC 死亡的 10 年累积发生率相似（28.9% vs 30.2%，p=0.954；21.6% vs 13.4%，p=0.840；12.9% vs 24.5%，p=0.494）。同样，10 年 OS 和 DFS 也相似（80.0% vs 75.5%，p=0.975 和 68.0% vs 69.8%，p=0.836）。具有宏转移 SLN 的患者的 OS 和 DFS 均较低（60.2%和 47.5%）。
微转移 SLN 患者的结局与无疾病 SLN 患者相似，优于宏转移 SLN 患者。
