Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2022 Apr;29(4):2263-2272. doi: 10.1245/s10434-021-11140-5. Epub 2022 Jan 7.
Omission of sentinel lymph node biopsy (SLNB) in older women with clinically node-negative, hormone receptor-positive (HR+) early-stage breast cancer undergoing lumpectomy is accepted, given established low rates of regional recurrence. The safety of omitting SLNB in women undergoing mastectomy is unknown and may differ depending on extent of breast disease and variation in radiotherapy use.
From 2006 to 2018, 123 cTis and 328 cT1-2 HR+/HER2- tumors from 410 women aged ≥ 70 years who underwent mastectomy and SLNB were included (41 bilateral cases). The rate of nodal positivity and effect of nodal positivity on adjuvant therapy use were examined.
Median age was 74 years; 21% of patients had positive sentinel lymph nodes, 7% had micrometastases, and 14% had macrometastases. Of cases of cTis tumors, 31% were upstaged to invasive carcinoma; 1% had macrometastases. Fewer cases of cT1 than cT2 tumors had macrometastases [13% (26/200) versus 29% (37/128); p < 0.001]. Eight percent of patients with pT1 tumors (18/228) and 27% of patients with pT2 tumors (30/113) received chemotherapy. Most patients with pT1, pN1 disease (78%; 25/32) did not receive chemotherapy. Rates of locoregional recurrence were similar between patients with cT1 or cT2 tumors with and without nodal metastases (median follow-up, 4.5 years).
Women aged ≥ 70 years with cTis and cT1N0 HR+/HER2- tumors who underwent mastectomy had low rates of nodal positivity, similar to rates reported for lumpectomy. Given this and the RxPONDER results, omission of SLNB may be considered, as findings are unlikely to alter adjuvant therapy recommendations.
对于接受保乳切除术的临床淋巴结阴性、激素受体阳性（HR+）早期乳腺癌的老年女性，已接受了省略前哨淋巴结活检（SLNB），因为区域复发率较低。在接受乳房切除术的女性中省略 SLNB 的安全性尚不清楚，并且可能因乳房疾病的严重程度和放疗使用的变化而有所不同。
2006 年至 2018 年，纳入了 410 名年龄≥70 岁的接受乳房切除术和 SLNB 的 cTis 和 328 例 cT1-2 HR+/HER2-肿瘤的患者（41 例双侧病例）。检查了淋巴结阳性率以及淋巴结阳性对辅助治疗使用的影响。
中位年龄为 74 岁；21%的患者有前哨淋巴结阳性，7%有微转移，14%有宏转移。cTis 肿瘤中，31%升级为浸润性癌；1%有宏转移。cT1 病例比 cT2 肿瘤的宏转移病例少[13%（26/200）比 29%（37/128）；p<0.001]。pT1 肿瘤患者中有 8%（18/228）和 pT2 肿瘤患者中有 27%（30/113）接受了化疗。大多数 pT1、pN1 疾病患者（78%；25/32）未接受化疗。cT1 或 cT2 肿瘤伴或不伴淋巴结转移的患者局部区域复发率相似（中位随访时间为 4.5 年）。
接受乳房切除术的 cTis 和 cT1N0 HR+/HER2- 肿瘤的年龄≥70 岁的女性淋巴结阳性率较低，与保乳术报告的率相似。鉴于这一点以及 RxPONDER 的结果，可以考虑省略 SLNB，因为结果不太可能改变辅助治疗建议。
