2nd Academic Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54624, Thessaloníki, Greece.
4th Academic Department of General Surgery, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
Arch Gynecol Obstet. 2022 Oct;306(4):1221-1234. doi: 10.1007/s00404-022-06458-8. Epub 2022 Mar 5.
ΟBJECTIVE: This study aimed at comparing survival outcomes between systematic axillary lymph node dissection (ALND) vs sentinel lymph node and axillary lymph node dissection only if sentinel positive (SLN ± ALND) in early-stage, clinically node-negative breast cancer patients. ΜETHODS: A systematic review and meta-analysis adhered to PRISMA guidelines was performed. Included studies were prospective randomized controlled trials (RCTs) comparing survival outcomes of ALND vs. SLN ± ALND in early-stage, node-negative breast cancer patients. Patients enrolled were only those with tumor size lower than 4 cm, clinically negative nodes and treated with breast-conservative surgery. Primary endpoints were locoregional recurrence, overall death and cancer-related death. RESULTS: There were four studies included in the analysis, enrolling overall 2982 patients, of which 1494 in ALND arm and 1488 in the SLN ± ALND arm. No statistically significant difference was observed in locoregional recurrence, breast cancer-related death and overall death. Locoregional recurrence was observed in 2.8% (ALND) vs. 4.1% (SLND ± ALND), (RR 0.69, 95% CI 0.20-2.30). Overall death rate was 7.0% vs. 6.8% respectively, (RR 1.00, 95% CI 0.73-1.39, I = 28.7%). Breast cancer-related death was 3.6% vs. 3.5%, respectively (SLN ± ALND), (RR 1.11, 95% CI 0.70-1.78, I = 0%). No statistically significant difference was observed in any of secondary study outcomes. CONCLUSIONS: Systematic axillary axillary lymph node dissection provides no survival benefit compared with sentinel lymph node dissection for early-stage clinically node-negative breast cancer patients.
本研究旨在比较早期临床淋巴结阴性乳腺癌患者行系统性腋窝淋巴结清扫术（ALND）与前哨淋巴结活检加腋窝淋巴结清扫术（SLN ± ALND）的生存结果。
我们进行了一项系统的综述和荟萃分析，严格遵循 PRISMA 指南。纳入的研究为比较早期临床淋巴结阴性乳腺癌患者行 ALND 与 SLN ± ALND 的生存结果的前瞻性随机对照试验（RCT）。入组患者仅为肿瘤直径小于 4 cm、临床淋巴结阴性且接受保乳手术治疗的患者。主要终点为局部区域复发、总死亡和癌症相关死亡。
共有四项研究纳入分析，共纳入 2982 例患者，其中 ALND 组 1494 例，SLN ± ALND 组 1488 例。两组在局部区域复发、乳腺癌相关死亡和总死亡方面无统计学差异。局部区域复发分别为 2.8%（ALND）和 4.1%（SLND ± ALND）（RR 0.69，95% CI 0.20-2.30）。总死亡率分别为 7.0%和 6.8%（RR 1.00，95% CI 0.73-1.39，I²=28.7%）。乳腺癌相关死亡率分别为 3.6%和 3.5%（SLND ± ALND）（RR 1.11，95% CI 0.70-1.78，I²=0%）。任何次要研究结果均无统计学差异。
与 SLN 活检加腋窝淋巴结清扫术相比，早期临床淋巴结阴性乳腺癌患者行系统性腋窝淋巴结清扫术并未带来生存获益。
