Department of Surgery, Section of Surgical Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Section of Hematology/Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Ann Surg Oncol. 2023 Sep;30(9):5610-5618. doi: 10.1245/s10434-023-13475-7. Epub 2023 May 19.
Male breast cancer (MBC) is rare, and management is extrapolated from trials that enroll only women. It is unclear whether contemporary axillary management based on data from landmark trials in women may also apply to men with breast cancer. This study aimed to compare survival in men with positive sentinel lymph nodes after sentinel lymph node biopsy (SLNB) alone versus complete axillary dissection (ALND).
Using the National Cancer Database, men with clinically node-negative, T1 and T2 breast cancer and 1-2 positive sentinel nodes who underwent SLNB or ALND were identified from 2010 to 2020. Both 1:1 propensity score matching and multivariate regression were used to identify patient and disease variables associated with ALND versus SLNB. Survival between ALND and SLNB were compared using Kaplan-Meier methods.
A total of 1203 patients were identified: 61.1% underwent SLNB alone and 38.9% underwent ALND. Treatment in academic centers (36.1 vs. 27.7%; p < 0.0001), 2 positive lymph nodes on SLNB (32.9 vs. 17.3%, p < 0.0001) and receipt or recommendation of chemotherapy (66.5 vs. 52.2%, p < 0.0001) were associated with higher likelihood of ALND. After propensity score matching, ALND was associated with superior survival compared with SLNB (5-year overall survival of 83.8 vs. 76.0%; log-rank p = 0.0104).
The results of this study suggest that among patients with early-stage MBC with limited sentinel lymph node metastasis, ALND is associated with superior survival compared with SLNB alone. These findings indicate that it may be inappropriate to extrapolate the results of the ACOSOG Z0011 and EORTC AMAROS trials to MBC.
男性乳腺癌（MBC）较为罕见，其治疗方法是从仅纳入女性的试验中推断得出的。目前尚不清楚基于女性标志性试验数据的当代腋窝管理方法是否也适用于男性乳腺癌患者。本研究旨在比较单独进行前哨淋巴结活检（SLNB）后前哨淋巴结阳性的男性患者与接受完全腋窝清扫（ALND）的患者的生存情况。
利用国家癌症数据库，自 2010 年至 2020 年，我们筛选出临床淋巴结阴性、T1 和 T2 期乳腺癌且有 1-2 个前哨淋巴结阳性的男性患者，这些患者接受了 SLNB 或 ALND。我们使用 1:1 倾向评分匹配和多变量回归来确定与 ALND 与 SLNB 相关的患者和疾病变量。使用 Kaplan-Meier 方法比较 ALND 与 SLNB 之间的生存情况。
共纳入 1203 例患者：61.1%的患者接受了单纯 SLNB，38.9%的患者接受了 ALND。在学术中心接受治疗（36.1%比 27.7%；p<0.0001）、SLNB 上有 2 个阳性淋巴结（32.9%比 17.3%，p<0.0001）以及接受或建议化疗（66.5%比 52.2%，p<0.0001）与 ALND 更有可能相关。经过倾向评分匹配后，与 SLNB 相比，ALND 与更好的生存相关（5 年总生存率分别为 83.8%和 76.0%；log-rank p=0.0104）。
本研究结果表明，在早期 MBC 伴有限前哨淋巴结转移的患者中，与单纯 SLNB 相比，ALND 与更好的生存相关。这些发现表明，将 ACOSOG Z0011 和 EORTC AMAROS 试验的结果外推至 MBC 可能并不合适。
