Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
University of South Florida College of Medicine, Tampa, FL, USA.
Ann Surg Oncol. 2022 May;29(5):2985-2997. doi: 10.1245/s10434-021-11194-5. Epub 2022 Jan 10.
The role of sentinel lymph node biopsy (SLNB) in triple-negative breast cancer (TNBC) patients who present with clinical N1 (cN1) disease and undergo complete clinical response (cCR) to neoadjuvant systemic therapy (NAST) remains unclear. We aimed to study the outcomes of SLNB versus axillary lymph node dissection (ALND) in this setting.
Patients with cN1 TNBC who showed cCR to NAST were selected from the National Cancer Database (NCDB), and propensity score matched 1:1 between SLNB and ALND in all-comers, ypN0, and ypN1 subgroups. Overall survival (OS) was compared using the Kaplan-Meier method. Cox regression was used to identify predictors of OS.
Of the 2953 patients selected. 1062 (36.0%) underwent SLNB and 1891 (64.0%) underwent ALND. There was a chronological increase in national SLNB utilization (from 20% in 2012 to 46% in 2017). One thousand three patients were propensity matched between SLNB and ALND, and no OS difference was noted (81.73 ± 1.04 vs. 80.07 ± 0.70 months; p = 0.127). In the ypN0 subgroup, 884 pairs were matched and no significant OS difference was found (85.29 ± 0.84 vs. 82.60 ± 0.68 months; p = 0.638). In ypN+ patients, 129 pairs were matched and demonstrated a trend toward decreased OS with SLNB (64.37 ± 3.12 vs. 72.45 ± 72.45; p = 0.085). Cox regression identified age, inner tumors, advanced T stage, partial/no in-breast response, and nodal status as unfavorable predictors of OS. Definitive axillary surgical procedure was not a predictor in the final model.
SLNB and ALND appear to yield comparable OS in cN1 TNBC patients who demonstrate cCR to NAST. Caution should be exercised in ypN1 patients as worse OS could be associated with SLNB.
在临床 N1（cN1）疾病且新辅助全身治疗（NAST）完全临床缓解（cCR）的三阴性乳腺癌（TNBC）患者中，前哨淋巴结活检（SLNB）的作用尚不清楚。我们旨在研究这种情况下 SLNB 与腋窝淋巴结清扫术（ALND）的结果。
从国家癌症数据库（NCDB）中选择 cN1 TNBC 患者，这些患者对 NAST 有 cCR，并在所有患者、ypN0 和 ypN1 亚组中对 SLNB 和 ALND 进行 1:1 的倾向评分匹配。使用 Kaplan-Meier 方法比较总生存期（OS）。使用 Cox 回归识别 OS 的预测因素。
在 2953 名入选患者中，1062 名（36.0%）接受了 SLNB，1891 名（64.0%）接受了 ALND。全国范围内 SLNB 的使用率呈时间性增加（从 2012 年的 20%增加到 2017 年的 46%）。1300 名患者在 SLNB 和 ALND 之间进行了倾向评分匹配，未观察到 OS 差异（81.73±1.04 vs.80.07±0.70 个月；p=0.127）。在 ypN0 亚组中，884 对患者进行了匹配，未发现显著的 OS 差异（85.29±0.84 vs.82.60±0.68 个月；p=0.638）。在 ypN+患者中，129 对患者进行了匹配，SLNB 显示 OS 呈下降趋势（64.37±3.12 vs.72.45±72.45；p=0.085）。Cox 回归确定年龄、内部肿瘤、晚期 T 期、部分/无乳房内反应和淋巴结状态为 OS 的不利预测因素。最终模型中，明确的腋窝手术程序不是预测因素。
在对 NAST 有 cCR 的 cN1 TNBC 患者中，SLNB 和 ALND 似乎产生了相当的 OS。在 ypN1 患者中应谨慎，因为较差的 OS 可能与 SLNB 相关。
