Spectrum Health/Michigan State University General Surgery Residency, Grand Rapids, MI, USA.
Spectrum Health Medical Group Comprehensive Breast Clinic, Grand Rapids, MI, USA.
Ann Surg Oncol. 2021 Oct;28(10):5716-5722. doi: 10.1245/s10434-021-10460-w. Epub 2021 Jul 31.
BACKGROUND: In 2016, the Society of Surgical Oncology released a Choosing Wisely guideline recommending sentinel lymph node biopsy (SLNB) omission in females ≥70 years of age with early-stage, hormone-positive, clinically node-negative invasive breast cancer. This study investigated the impact of this guideline on SLNB and radiotherapy rates, in addition to assessing temporal trends of nodal biopsy and factors associated with recurrence. METHODS: The study involved a retrospective review of women who met the guideline criteria and underwent partial mastectomy at a single institution between 2009 and 2018. Using the same inclusion criteria, the National Cancer Database was queried to obtain a separate dataset. Statistical analyses included univariate comparisons, and multivariate logistic regression modeling to predict radiotherapy delivery. RESULTS: In our institutional series, 487 patients were included, 274 (56.3%) of whom received radiotherapy. There were 414 patients (85.0%) who underwent SLNB, with a nodal positivity rate of 11%. SLNB correlated with higher rates of radiotherapy (63.5% vs. 15.1%, p < 0.001). Age <80 years was an independent predictor of radiotherapy receipt (odds ratio 3.0, 95% confidence interval 0.22-0.52). SLNB performance decreased after 2016 (88.4% vs. 78.4%, p = 0.003). Median follow-up was 4.8 years, with 19 (3.9%) documented recurrences. SLNB performance was not associated with recurrence (2.9% vs. 5.5%, p = 0.279), whereas radiotherapy resulted in reduced recurrence (1.1% vs. 6.1%, p = 0.002). One (0.2%) disease-related mortality was observed. CONCLUSION: Recurrence rates and disease-related mortality remain low in this demographic regardless of treatment rendered. Omission of SLNB and radiotherapy should remain a consideration, and efforts in both patient and physician education should continue.
背景：2016 年，外科肿瘤学会发布了一项明智选择指南，建议对年龄≥70 岁、患有早期、激素阳性、临床淋巴结阴性浸润性乳腺癌的女性，省略前哨淋巴结活检（SLNB）。本研究旨在调查该指南对 SLNB 和放疗率的影响，同时评估淋巴结活检的时间趋势以及与复发相关的因素。
方法：本研究回顾性分析了在一家机构接受符合该指南标准的部分乳房切除术的女性，纳入时间为 2009 年至 2018 年。使用相同的纳入标准，在国家癌症数据库中查询了另一个数据集。统计分析包括单变量比较和多变量逻辑回归模型预测放疗的实施。
结果：在本机构的研究中，纳入了 487 名患者，其中 274 名（56.3%）接受了放疗。有 414 名患者（85.0%）接受了 SLNB，淋巴结阳性率为 11%。SLNB 与更高的放疗率相关（63.5% vs. 15.1%，p<0.001）。年龄<80 岁是接受放疗的独立预测因素（优势比 3.0，95%置信区间 0.22-0.52）。2016 年后，SLNB 的实施率下降（88.4% vs. 78.4%，p=0.003）。中位随访时间为 4.8 年，有 19 例（3.9%）记录的复发。SLNB 的实施与复发无关（2.9% vs. 5.5%，p=0.279），而放疗可降低复发率（1.1% vs. 6.1%，p=0.002）。观察到 1 例（0.2%）与疾病相关的死亡。
结论：无论治疗方法如何，在这一年龄段，复发率和与疾病相关的死亡率仍然很低。应继续考虑省略 SLNB 和放疗，应继续对患者和医生进行教育。
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