新辅助化疗后腋窝淋巴结病理完全缓解的乳腺癌患者前哨淋巴结活检
Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy.
作者信息
Kim Hyunhee, Han Jaihong, Kim Sun-Young, Lee Eun Sook, Kang Han-Sung, Lee Seeyoun, Jung So-Youn, Lee EunGyeong
机构信息
Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea.
Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
出版信息
J Breast Cancer. 2021 Dec;24(6):531-541. doi: 10.4048/jbc.2021.24.e48.
PURPOSE
Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph node-positive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC.
METHODS
This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND.
RESULTS
This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6-155) in the SLNB group and 99 (range 2-159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% ( = 0.392), and 89.2% and 86.4% ( = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, < 0.001).
CONCLUSION
As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.
目的
对于初始淋巴结阳性的乳腺癌患者，新辅助化疗（NAC）后仅行前哨淋巴结活检（SLNB）仍存在争议。本研究旨在评估SLNB和腋窝淋巴结清扫术（ALND）对NAC后从淋巴结阳性转为病理淋巴结阴性（ypN0）的患者乳腺癌复发及生存的影响。
方法
本单中心回顾性研究纳入了223例NAC后转为腋窝淋巴结阴性状态并于2006年1月至2015年12月期间接受乳腺和腋窝手术的患者。本研究比较了SLNB组和ALND组的总生存期（OS）、无病生存期（DFS）、同侧腋窝淋巴结复发率及术后并发症发生率，尤其是手臂淋巴水肿和肩部僵硬情况。
结果
本研究纳入了223例NAC及手术后腋窝病理完全缓解（pCR）的患者。SLNB组和ALND组分别有94例和129例患者。SLNB组的中位随访时间为57（范围6 - 155）个月，ALND组为99（范围2 - 159）个月。相应的5年OS率和DFS率分别为96.3%和94.2%（P = 0.392），以及89.2%和86.4%（P = 0.671）。SLNB组有4例（4.3%）患者和ALND组有9例（7.0%）患者发生局部区域复发。同侧腋窝淋巴结复发和远处转移分别在1例（1.1%）和3例（2.3%）SLNB组患者以及10例（10.6%）和11例（8.5%）ALND组患者中观察到。ALND组患者比SLNB组患者更易出现并发症，如肩部僵硬（9例[7.0%]对4例[4.3%]患者，P = 0.57）。ALND组的淋巴水肿发生率是SLNB组的3倍（35例[27.1%]对8例[8.5%]患者，P < 0.001）。
结论
作为ALND的替代方法，SLNB对NAC后腋窝病理完全缓解的患者具有肿瘤学安全性。
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