T3-4c 期乳腺癌女性患者前哨淋巴结活检与腋窝淋巴结清扫的生存比较。
Survival After Sentinel Lymph Node Biopsy Compared with Axillary Lymph Node Dissection for Female Patients with T3-4c Breast Cancer.
机构信息
Department of Breast Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Medical University, Guangzhou, People's Republic of China.
Department of Breast Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
出版信息
Oncologist. 2023 Aug 3;28(8):e591-e599. doi: 10.1093/oncolo/oyad038.
BACKGROUND
For patients with cN0 and T1-2 breast cancer, sentinel lymph node biopsy (SLNB) can provide survival results equivalent to axillary lymph node dissection (ALND). However, whether it can be performed on T3-4c patients is still controversial.
MATERIALS AND METHODS
Female patients diagnosed with cN0, T3-4c, and M0 breast cancer from 2004 to 2019 were identified using the surveillance, epidemiology and end results (SEER) database and divided into 2 groups, the SLNB group (1-5 regional lymph nodes examined) and the ALND group (≥10 regional lymph nodes examined). Finally, only those with pN0 disease were included in the SLNB group. The baseline differences in clinicopathological characteristics between groups were eliminated by propensity score matching (PSM). We also conducted subgroup analyses according to age, overall TNM stage, breast cancer subtypes, surgical approaches, radiation therapy, and chemotherapy. The primary endpoint was survival.
RESULTS
With a mean follow-up of 75 months, a total of 186 deaths were reported among 864 patients. The overall survival (OS) and breast cancer-specific survival (BCSS) in the SLNB group were 78.2% and 87.5%, respectively, and that in the ALND group were 78.7% and 87.3%, respectively. The unadjusted hazard ratio (HR) for OS and BCSS in the SLNB group (vs. the ALND group) was 0.922 (95% CI, 0.691-1.230, P = .580) and 0.874 (95% CI, 0.600-1.273, P = .481), respectively. Besides, the OS and BCSS between the 2 groups were also similar in all subgroup analyses.
CONCLUSIONS
SLNB may be performed on female patients with cN0, T3-4c, and M0 breast cancer.
背景
对于 cN0 和 T1-2 期乳腺癌患者，前哨淋巴结活检（SLNB）可提供与腋窝淋巴结清扫（ALND）相当的生存结果。然而，对于 T3-4c 患者是否可以进行 SLNB 仍存在争议。
材料和方法
使用监测、流行病学和最终结果（SEER）数据库，对 2004 年至 2019 年间诊断为 cN0、T3-4c 和 M0 乳腺癌的女性患者进行分组，分为 SLNB 组（检查 1-5 个区域淋巴结）和 ALND 组（检查≥10 个区域淋巴结）。最后，仅将 pN0 疾病患者纳入 SLNB 组。通过倾向评分匹配（PSM）消除组间临床病理特征的基线差异。我们还根据年龄、总 TNM 分期、乳腺癌亚型、手术方式、放疗和化疗进行了亚组分析。主要终点是生存。
结果
在平均随访 75 个月后，864 例患者中共有 186 例死亡。SLNB 组的总生存率（OS）和乳腺癌特异性生存率（BCSS）分别为 78.2%和 87.5%，ALND 组分别为 78.7%和 87.3%。SLNB 组（与 ALND 组相比）的 OS 和 BCSS 未调整的风险比（HR）分别为 0.922（95%CI，0.691-1.230，P=0.580）和 0.874（95%CI，0.600-1.273，P=0.481）。此外，两组在所有亚组分析中的 OS 和 BCSS 也相似。
结论
SLNB 可用于 cN0、T3-4c 和 M0 乳腺癌的女性患者。
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