Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China.
Breast Cancer Res Treat. 2022 Nov;196(1):129-141. doi: 10.1007/s10549-022-06727-9. Epub 2022 Sep 8.
This study aimed to evaluate whether axillary lymph node dissection (ALND) can be omitted in patients with 1-2 positive sentinel lymph nodes (SLNs) who received total mastectomy (TM).
Consecutive breast cancer patients with 1-2 positive SLNs were retrospectively reviewed from a multi-institutional database. Patients were divided into sentinel lymph node biopsy (SLNB) group and ALND group. Administration of adjuvant chemotherapy and survival were compared between groups. To further verify the results, a meta-analysis was also conducted.
Among the 1161 enrolled patients, 893 (76.9%) received ALND and 268 (23.1%) underwent SLNB alone. Administration of chemotherapy was comparable between the two groups (91.1% vs. 90.6%, P = 0.798), which was consistent in TM (P = 0.638) and BCS cohort (P = 0.576). After a median follow-up of 36 months, no significant difference was observed between the two groups in recurrence-free survival (P = 0.583) regardless of surgery of breast. During further meta-analysis, 13 out of 4733 relative studies reported the association of axillary surgery and disease-free survival (DFS) or overall survival (OS) in 1-2 positive SLNs patients. Pooled analysis showed no difference in adjusted DFS (HR 0.84, 95% CI 0.70-1.02) or OS (HR 1.02, 95% CI 0.93-1.11) between SLNB and ALND groups. Survival benefit of ALND remained non-significant after restricting the analysis in four studies with patients only receiving BCS, or in three studies with patients only receiving TM.
Further ALND does not impact adjuvant chemotherapy administration or disease outcome in breast cancer patients with 1-2 positive SLNs treated with TM.
本研究旨在评估对于接受全乳切除术（TM）的 1-2 个前哨淋巴结（SLN）阳性的患者，是否可以省略腋窝淋巴结清扫术（ALND）。
回顾性分析来自多机构数据库的连续乳腺癌患者，这些患者的 1-2 个 SLN 阳性。将患者分为前哨淋巴结活检（SLNB）组和 ALND 组。比较两组辅助化疗的应用和生存情况。为了进一步验证结果，还进行了荟萃分析。
在纳入的 1161 例患者中，893 例（76.9%）接受了 ALND，268 例（23.1%）单独进行了 SLNB。两组化疗的应用无差异（91.1%比 90.6%，P=0.798），在 TM 和 BCS 队列中均一致（P=0.638 和 P=0.576）。中位随访 36 个月后，两组在无复发生存率（P=0.583）方面无显著差异，无论乳房手术如何。在进一步的荟萃分析中，4733 项相关研究中有 13 项报告了腋窝手术与 1-2 个 SLN 阳性患者的无病生存（DFS）或总生存（OS）之间的关联。汇总分析显示，SLNB 和 ALND 两组之间调整后的 DFS（HR 0.84，95%CI 0.70-1.02）或 OS（HR 1.02，95%CI 0.93-1.11）无差异。在仅接受 BCS 的四项研究或仅接受 TM 的三项研究中限制分析后，ALND 的生存获益仍然无统计学意义。
对于接受 TM 的 1-2 个 SLN 阳性乳腺癌患者，进一步的 ALND 不会影响辅助化疗的应用或疾病结局。
