Department of Pathology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
Department of Breast Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
Cancer. 2023 May 15;129(10):1492-1501. doi: 10.1002/cncr.34708. Epub 2023 Feb 19.
There is a lack of studies assessing the survival of repeat sentinel lymph node biopsy (rSLNB) versus axillary lymph node dissection (ALND) for surgical axillary staging among patients with ipsilateral breast tumor recurrence (IBTR).
We retrospectively identified patients with IBTR from the Surveillance, Epidemiology, and End Results database from 2000 to 2017. The primary outcome was overall survival (OS) between the rSLNB and ALND groups.
Of the 2141 women with IBTR after lumpectomy and SLNB, 524 did not receive surgical axillary staging (nonsurgery group) and 1617 patients who did undergo axilla surgery received either rSLNB or ALND as axillary staging (1268 with rSLNB and 349 with ALND). The 10-year OS rates were 61.9% for the nonsurgery and 73.8% for axilla surgery groups (p = .001). In the 1:1 matched cohorts, the 10-year OS rates were 61.4% for the nonsurgery and 69.1% for axilla surgery groups (p = .072). After adjusting for other factors, axillary surgery treatment of IBTR was an independent favorable factor for OS (hazard ratio [HR], 0.71; 95% CI, 0.56-0.90; p = .004). Within the axilla surgery group, rSLNB presented a comparable 10-year OS to the ALND cohort (log-rank test p = .054). Multivariate Cox analysis, as well as subgroup analysis, showed that rSLNB had a similar benefit to ALND (10-year OS; HR, 1.18; 95% CI, 0.88-1.58; p = .268).
The results of this cohort study suggested that receiving surgical axillary staging was associated with better survival of IBTR patients, and rSLNB had a similar long-term survival outcome as ALND. rSLNB might be considered for surgical axillary staging among patients with IBTR after lumpectomy and initial SLNB.
对于同侧乳房肿瘤复发（IBTR）患者的手术腋窝分期，重复前哨淋巴结活检（rSLNB）与腋窝淋巴结清扫术（ALND）相比，其生存情况的研究较少。
我们从 2000 年至 2017 年的监测、流行病学和最终结果数据库中回顾性地确定了 IBTR 患者。主要结局是 rSLNB 组和 ALND 组之间的总生存（OS）。
在接受保乳术和 SLNB 后的 2141 例 IBTR 女性中，524 例未接受手术腋窝分期（非手术组），1617 例接受腋窝手术的患者接受了 rSLNB 或 ALND 作为腋窝分期（1268 例接受 rSLNB，349 例接受 ALND）。非手术组和腋窝手术组的 10 年 OS 率分别为 61.9%和 73.8%（p=0.001）。在 1:1 匹配队列中，非手术组和腋窝手术组的 10 年 OS 率分别为 61.4%和 69.1%（p=0.072）。在调整其他因素后，IBTR 的腋窝手术治疗是 OS 的独立有利因素（风险比[HR]，0.71；95%置信区间，0.56-0.90；p=0.004）。在腋窝手术组内，rSLNB 的 10 年 OS 与 ALND 队列相当（对数秩检验 p=0.054）。多变量 Cox 分析以及亚组分析显示，rSLNB 与 ALND 具有相似的获益（10 年 OS；HR，1.18；95%置信区间，0.88-1.58；p=0.268）。
这项队列研究的结果表明，接受手术腋窝分期与 IBTR 患者的生存改善相关，并且 rSLNB 与 ALND 的长期生存结果相似。对于接受保乳术和初始 SLNB 后的 IBTR 患者，rSLNB 可考虑用于手术腋窝分期。
