Department of Surgery, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, 04764, Seoul, South Korea.
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
World J Surg Oncol. 2022 Jun 13;20(1):198. doi: 10.1186/s12957-022-02673-4.
Since the publication of the Z0011 trial, practice-changing clinical guidelines for breast surgery have been developed. Although recent studies confirmed the feasibility of the Z0011 strategy in Asian populations, there has been no study on the trends of axillary surgery in Asian cohort. This study aimed to investigate the time trend of axillary surgery for breast cancer from a Korean Breast Cancer Registry to understand the impact of the Z0011 trial in Asian patients.
We collected prospectively constructed data from the nationwide Korean Breast Cancer Registry (KBCR). We identified patients who underwent sentinel node biopsy followed by breast-conserving surgery from 2011 to 2018 and were found to have pathological stage T1-2N1-3M0 disease. Regression analyses were performed to compare the downward trend of axillary lymph node dissection (ALND) in Korean cohort with that previously reported in a Dutch cohort.
From KBCR data, 7478 patients met the inclusion criteria. The proportion of ALND significantly decreased from 2011 (76.6%) to 2018 (47.5%). Multivariate analysis revealed that earlier years at diagnosis, larger tumor size, and lymphatic invasion were associated with a higher odds ratio of performing ALND. Compared to the Dutch cohort, the downward trend of ALND in Korea was significantly more gradual (annual percent change: 37.2 vs. 5.8%, p < 0.001).
This study demonstrated a downward trend of ALND in Korean patients with breast cancer. However, the rate of decrease was significantly slower than that in the Dutch cohort.
自 Z0011 试验发表以来，针对乳腺外科的临床实践指南发生了重大改变。尽管最近的研究证实了 Z0011 策略在亚洲人群中的可行性，但针对亚洲人群的腋窝手术趋势仍未有研究报道。本研究旨在通过韩国乳腺癌注册中心（KBCR）调查乳腺癌腋窝手术的时间趋势，以了解 Z0011 试验对亚洲患者的影响。
我们从全国性的韩国乳腺癌注册中心（KBCR）中收集前瞻性构建的数据。我们从 2011 年至 2018 年期间，确定了接受前哨淋巴结活检和保乳手术后病理分期为 T1-2N1-3M0 的患者。我们通过回归分析比较韩国队列和荷兰队列中腋窝淋巴结清扫术（ALND）的下降趋势。
从 KBCR 数据中，我们纳入了 7478 例符合条件的患者。ALND 的比例从 2011 年的 76.6%显著下降到 2018 年的 47.5%。多变量分析显示，诊断时的年份更早、肿瘤较大和淋巴管浸润与进行 ALND 的可能性更高有关。与荷兰队列相比，韩国 ALND 的下降趋势明显更为缓慢（年变化百分比：37.2% vs. 5.8%，p < 0.001）。
本研究表明韩国乳腺癌患者的 ALND 呈下降趋势。然而，下降速度明显慢于荷兰队列。
