Department of Pathology, Hospital Universitario de Jaén, Jaén, Spain.
Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
Breast Cancer Res Treat. 2023 Jul;200(2):203-215. doi: 10.1007/s10549-023-06954-8. Epub 2023 May 23.
This study aimed to compare the prognosis in terms of disease-free survival (DFS) in three populations of women with breast cancer (BC) treated with neoadjuvant systemic treatment (NAST) in which axillary lymph node dissection (ALND) was performed based on different total tumor load (TTL) thresholds in the sentinel nodes.
This was an observational, retrospective study carried out in three Spanish centers. Data from patients with infiltrating BC who underwent BC surgery after NAST and intraoperative sentinel lymph node biopsy (SLNB) performed by One Step Nucleic acid Amplification (OSNA) technique during 2017 and 2018 were analyzed. ALND was performed according to the protocol of each center, based on three different TTL cut-offs (TTL > 250, TTL > 5000, and TTL > 15,000 CK19-mRNA copies/μL for centers 1, 2, and 3, respectively).
A total of 157 BC patients were included in the study. No significant differences in DFS were observed between centers (Hazard ratio [HR] center 2 vs 1: 0.77; p = 0.707; HR center 3 vs 1: 0.83; p = 0.799). Patients with ALND had a shorter DFS (HR 2.43; p = 0.136), albeit not statistically significant. Patients with a triple negative subtype had a worse prognosis than those with other molecular subtypes (HR 2.82; p = 0.056).
No significant differences in DFS were observed between three centers with different surgical approaches to ALND based on different TTL cut-offs in patients with BC after NAST. These results suggest that restricting ALND to those patients with TTL ≥ 15,000 copies/μL is a reliable approximation, avoiding unnecessary morbidities caused by ALND.
本研究旨在比较三种新辅助全身治疗（NAST）后接受腋窝淋巴结清扫（ALND）的乳腺癌（BC）患者的无病生存（DFS）预后，这些患者的前哨淋巴结中的总肿瘤负荷（TTL）基于不同的阈值。
这是一项在西班牙三个中心进行的观察性、回顾性研究。分析了 2017 年至 2018 年间接受 NAST 后行 BC 手术且术中通过一步核酸扩增（OSNA）技术行前哨淋巴结活检（SLNB）的浸润性 BC 患者的数据。ALND 是根据每个中心的方案进行的，基于三个不同的 TTL 截止值（分别为中心 1、2 和 3 的 TTL＞250、TTL＞5000 和 TTL＞15,000 CK19-mRNA 拷贝/μL）。
共纳入 157 例 BC 患者。三个中心之间的 DFS 无显著差异（中心 2 与 1 的 HR：0.77；p=0.707；中心 3 与 1 的 HR：0.83；p=0.799）。接受 ALND 的患者 DFS 更短（HR 2.43；p=0.136），但无统计学意义。三阴性亚型患者的预后较其他分子亚型差（HR 2.82；p=0.056）。
在新辅助 NAST 后接受基于不同 TTL 截止值的不同 ALND 手术方法的三个中心之间，DFS 无显著差异。这些结果表明，将 ALND 限制在 TTL≥15,000 拷贝/μL 的患者是一种可靠的近似方法，可以避免因 ALND 引起的不必要的发病率。
