Luz Felipe A C, Araújo Rogério A, Silva Marcelo J B
Center for Projects, Prevention and Research in Cancer at the Hospital do Câncer in Uberlândia, Uberlândia, Brazil.
Laboratory of Tumors Osteoimmunology and Immunology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil.
Front Oncol. 2021 Jul 19;11:669890. doi: 10.3389/fonc.2021.669890. eCollection 2021.
Sentinel-lymph-node (SLN) biopsy (SLB) is an efficient and safe axillary surgical approach with decreased morbidity than total axillary lymph node dissection (ALND) in initial patients (T1-T2). Current guidelines strongly suggest avoiding completion of ALND in patients with one or two positive SLNs that will be submitted to whole-breast radiation therapy, but must be done when three SLNs are affected.
We performed a SEER-based study with breast invasive ductal carcinoma patients treated between 2010 and 2015. Optimal cutoffs of positive LNs predictive of survival were obtained with ROC curves and survival as a continuous variable. Bias was reduced through propensity score matching. Cox regression was employed to estimate prognosis. Nomograms were constructed to analyze the predictive value of clinicopathological factors for axillary burden.
Of 43,239 initial patients that had one to three analyzed LNs, only 425 had two positive LNs and matched analysis demonstrated no survival difference versus pN2 patients [HR: 0.960 (0.635-1.452), 0.846]. The positive-to-analyzed LN proportion demonstrated a strong prognostic factor for a low rate (1 positive to ≤1.5 analyzed) [HR = 1.567 (1.156-2.126), 0.004], and analysis derived from the results demonstrated that a "negative LN margin" improves survival. Nomograms shows that tumor size is the main factor of axillary burden.
Macrometastasis of two LNs is a poor prognostic factor, similar to pN2, in SLNB (-like) patients; more extensive studies including preconized therapies must be done in order to corroborate or refute the resistance of this prognostic difference in patients with two macrometastatic lymph nodes within few resected.
前哨淋巴结（SLN）活检（SLB）是一种有效且安全的腋窝手术方法，与初始患者（T1 - T2）的全腋窝淋巴结清扫术（ALND）相比，发病率更低。当前指南强烈建议，对于接受全乳放疗且前哨淋巴结有一或两个阳性的患者，避免完成腋窝淋巴结清扫术，但当三个前哨淋巴结受累时则必须进行清扫。
我们对2010年至2015年间接受治疗的乳腺浸润性导管癌患者进行了一项基于监测、流行病学与最终结果（SEER）数据库的研究。通过绘制受试者工作特征（ROC）曲线并将生存作为连续变量，得出预测生存的阳性淋巴结的最佳截断值。通过倾向得分匹配减少偏差。采用Cox回归估计预后。构建列线图以分析临床病理因素对腋窝负荷的预测价值。
在43239例有一至三个分析淋巴结的初始患者中，仅有425例有两个阳性淋巴结，匹配分析显示与pN2患者相比生存无差异[风险比（HR）：0.960（0.635 - 1.452），P = 0.846]。阳性淋巴结与分析淋巴结的比例显示为低比例（1个阳性对≤1.5个分析淋巴结）的强预后因素[HR = 1.567（1.156 - 2.126），P = 0.004]，结果分析表明“阴性淋巴结边缘”可改善生存。列线图显示肿瘤大小是腋窝负荷的主要因素。
在类似前哨淋巴结活检的患者中，两个淋巴结出现大转移灶是不良预后因素，与pN2相似；必须开展包括推荐治疗在内的更广泛研究，以证实或反驳少数切除淋巴结中有两个大转移淋巴结的患者这种预后差异的抗性。
