Zhang Liang, Wang Xin Zhao, Li Chao, Yu Qian, Liu Zhaoyun, Yu Zhi Yong
Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Interventional Radiology, University of Chicago, Chicago, IL, United States.
Front Oncol. 2022 Apr 14;12:869397. doi: 10.3389/fonc.2022.869397. eCollection 2022.
Contralateral axillary lymph node metastasis (CAM) is classified as distant metastasis in guidelines, but the prognosis is better than that of stage IV patients. It is controversial to classify CAM as a distant metastasis or a regional metastasis, and the optimal treatment strategy for CAM is unknown.
Breast cancer patients who were confirmed by pathology and treated at Shandong Cancer Hospital between January 2012 and July 2021 were included in our study. We retrospectively reviewed the medical records of the patients for their clinical features, pathological diagnosis, treatment strategy, and follow-up data. Survival analysis was calculated by Kaplan-Meier analysis, and patient matching was performed by case-control matching.
A total of 60 patients were included, and there were 49 metachronous CAM cases and 11 synchronous CAM cases. The prognosis of isolated CAM patients was better than that of patients with other distant metastases in terms of CAM-OS and PFS with significant differences (median CAM-OS 71.0 vs. 30.0 months, P=0.022; median PFS 42.0 vs. 11.0 months, P=0.009) and OS without significant differences (median OS 126.0 vs. 79.0 months, P=0.111). The five-year survival rate of isolated CAM patients was 67.4%, and the five-year disease-free survival (DFS) rate was 52.9%. The prognosis of CAM patients was similar to that of N3M0 patients in terms of OS (mean OS 82.4 vs. 65.6 months, P=0.537) and DFS (mean PFS 54.5 vs. 52.6 months, P=0.888). Axillary lymph node dissection (ALND) or low-middle level ALND significantly improved the OS (mean OS 237.4 vs. 111.0 months, P=0.011), CAM-OS (mean CAM-OS 105.2 vs. 46.6 months, P = 0.002), and PFS (mean PFS 92.3 vs. 26.9 months, P = 0.001) of isolated CAM patients. Axillary radiotherapy improved PFS, CAM-OS, and OS but without significant differences (mean PFS 80.0 vs. 46.6 months, P = 0.345; mean CAM-OS 86.8 vs. 72.1 months, P = 0.338; mean OS 147.6 vs. 133.0 months, P = 0.426).
CAM should be diagnosed as local recurrence and treated with aggressive and curative rather than palliative strategies. Contralateral axillary surgery and radiotherapy are recommended for isolated CAM patients.
对侧腋窝淋巴结转移（CAM）在指南中被归类为远处转移，但其预后优于IV期患者。将CAM归类为远处转移还是区域转移存在争议，且针对CAM的最佳治疗策略尚不清楚。
纳入2012年1月至2021年7月在山东省肿瘤医院经病理确诊并接受治疗的乳腺癌患者。我们回顾性分析了患者的病历，包括其临床特征、病理诊断、治疗策略和随访数据。采用Kaplan-Meier分析计算生存分析，并通过病例对照匹配进行患者匹配。
共纳入60例患者，其中异时性CAM病例49例，同时性CAM病例11例。就CAM总生存期（CAM-OS）和无进展生存期（PFS）而言，孤立性CAM患者的预后优于其他远处转移患者，差异有统计学意义（CAM-OS中位数71.0个月对30.0个月，P=0.022；PFS中位数42.0个月对11.0个月，P=0.009），而总生存期（OS）无显著差异（OS中位数126.0个月对79.0个月，P=0.111）。孤立性CAM患者的五年生存率为67.4%，五年无病生存率（DFS）为52.9%。就OS（平均OS 82.4个月对65.6个月，P=0.537）和DFS（平均PFS 54.5个月对52.6个月，P=0.888）而言，CAM患者的预后与N3M0患者相似。腋窝淋巴结清扫（ALND）或中低位ALND显著改善了孤立性CAM患者的OS（平均OS 237.4个月对111.0个月，P=0.011）、CAM-OS（平均CAM-OS 105.2个月对46.6个月，P = 0.002）和PFS（平均PFS 92.3个月对26.9个月，P = 0.001）。腋窝放疗改善了PFS、CAM-OS和OS，但差异无统计学意义（平均PFS 80.0个月对46.6个月，P = 0.345；平均CAM-OS 86.8个月对72.1个月，P = 0.338；平均OS 147.6个月对133.0个月，P = 0.426）。
CAM应被诊断为局部复发，并采用积极的根治性而非姑息性策略进行治疗。推荐对孤立性CAM患者进行对侧腋窝手术和放疗。
