Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Chin Clin Oncol. 2021 Jun;10(3):27. doi: 10.21037/cco-20-239. Epub 2021 May 15.
The ACOSOG Z0011 trial demonstrated safe omission of axillary lymph node dissection (ALND) in patients with one or two positive sentinel lymph nodes (SLNs) receiving breast conservative surgery, followed by whole breast irradiation and adjuvant systemic treatment. This study aims to evaluate the exportability of the ACOSOG Z0011 criteria in an Asian/Chinese cohort residing in Hong Kong.
Retrospective analysis of a prospectively maintained database in a University affiliated tertiary breast centre was performed from June 2014 to May 2019. All breast cancer patients with no palpable adenopathy before surgery, one or more positive sentinel lymph nodes on histological examination and no prior neoadjuvant systemic treatment were recruited. Patients were grouped as eligible or ineligible according to the ACOSOG Z0011 criteria. The eligible group was compared with the sentinel alone group in the ACOSOG Z0011 cohort.
Two hundred and forty-eight patients were recruited into the study. Sixty patients (24%) met the ACOSOG Z0011 criteria and could potentially avoid ALND. A higher percentage of clinical T2 tumors were observed in our eligible group than in the ACOSOG Z0011 trial (P=0.002). The histological subtype, tumor grade, estrogen receptor (ER)/progestogen receptor (PR) status and lymphovascular invasion status did not differ. There was no statistically significant difference in the proportion of SLN micrometastasis and macrometastasis between the two groups.
This study demonstrated clinical similarities between our eligible cohort and the ACOSOG Z0011 cohort, which confirms exportability of the ACOSOG Z0011 criteria to a subset of population in Hong Kong.
ACOSOG Z0011 试验表明，对于接受保乳手术且仅存在 1 或 2 枚阳性前哨淋巴结（SLN）、随后接受全乳放疗和辅助全身治疗的患者，安全地省略腋窝淋巴结清扫术（ALND）是可行的。本研究旨在评估 ACOSOG Z0011 标准在香港居住的亚洲/华裔人群中的可推广性。
对一家大学附属医院的前瞻性维护数据库进行回顾性分析，研究时间为 2014 年 6 月至 2019 年 5 月。所有术前无可触及的淋巴结肿大、SLN 组织学检查存在 1 个或多个阳性淋巴结且无新辅助全身治疗的乳腺癌患者均被纳入研究。根据 ACOSOG Z0011 标准，将患者分为符合条件和不符合条件两组。将符合条件组与 ACOSOG Z0011 队列中的单独 SLN 组进行比较。
本研究共纳入 248 例患者。60 例（24%）符合 ACOSOG Z0011 标准，可潜在避免 ALND。与 ACOSOG Z0011 试验相比，我们的符合条件组中临床 T2 肿瘤的比例更高（P=0.002）。组织学亚型、肿瘤分级、雌激素受体（ER）/孕激素受体（PR）状态和脉管侵犯状态无差异。两组 SLN 微转移和宏转移的比例无统计学差异。
本研究表明，我们的符合条件组与 ACOSOG Z0011 队列具有临床相似性，这证实了 ACOSOG Z0011 标准可推广至香港的一部分人群。
