Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Department of Surgery, Suburban Hospital, Johns Hopkins Medicine, Bethesda, MD, USA.
Breast Cancer Res Treat. 2023 Nov;202(2):267-273. doi: 10.1007/s10549-023-07062-3. Epub 2023 Aug 2.
Axillary Lymph Node Dissection (ALND) is recommended for breast cancer patients who present with clinically node positive disease (cN1) especially if they have residual nodal disease (ypN+) following neoadjuvant therapy (NAT). It is unknown whether axillary dissection improves outcome for these patients.
A prospectively maintained database was used to identify all patients who were diagnosed with cTis-T4N1M0 breast cancer treated with NAT.
In our study, of 292 cN1 breast cancer patients who received NAT, we compared ALND with targeted axillary surgery (TAS) in ypN+ patients. ALND was performed in 75% of the ypN+ subgroup, while 25% underwent TAS. Axillary recurrence occurred in four ALND patients, but no recurrence was observed in the TAS group (p = 0.21). Five-year axillary recurrence-free survival was 100% for TAS and 90% for ALND (p = 0.21). Overall survival at five years was 97% for TAS and 85% for ALND (p = 0.39). Disease-free survival rates at five years were 51% for TAS and 61% for ALND (p = 0.9). Clinicopathological variables were similar between the groups, although some differences were noted. ALND patients had smaller clinical tumor size, larger pathological tumor size, more lymph nodes retrieved, larger tumor deposits, higher rates of extranodal extension, and greater prevalence of macrometastatic nodal disease. Tumor subtype and size of lymph node tumor deposit independently predicted survival.
Axillary recurrence is infrequent in cN1 patients treated with NAT. Our study found that ALND did not reduce the occurrence of axillary recurrence or enhance overall survival. It is currently uncertain which patients benefit from axillary dissection.
对于临床淋巴结阳性（cN1）的乳腺癌患者，尤其是新辅助治疗（NAT）后仍存在淋巴结残留疾病（ypN+）的患者，推荐行腋窝淋巴结清扫术（ALND）。目前尚不清楚腋窝清扫术是否能改善这些患者的预后。
使用前瞻性维护的数据库，确定所有接受 NAT 治疗的 cTis-T4N1M0 乳腺癌患者。
在我们的研究中，292 例接受 NAT 的 cN1 乳腺癌患者中，我们比较了 ypN+患者中 ALND 与靶向腋窝手术（TAS）的效果。ypN+亚组中 75%的患者行 ALND，25%的患者行 TAS。ALND 组有 4 例发生腋窝复发，而 TAS 组无复发（p=0.21）。TAS 组的 5 年腋窝无复发生存率为 100%，ALND 组为 90%（p=0.21）。TAS 组的 5 年总生存率为 97%，ALND 组为 85%（p=0.39）。TAS 组的 5 年无病生存率为 51%，ALND 组为 61%（p=0.9）。两组间临床病理变量相似，但也存在一些差异。ALND 组患者的临床肿瘤大小较小，病理肿瘤大小较大，腋窝淋巴结清扫数目较多，肿瘤转移灶较大，淋巴结外扩展率较高，且存在更多的宏转移淋巴结疾病。肿瘤亚型和淋巴结肿瘤转移灶的大小独立预测生存。
NAT 治疗的 cN1 患者腋窝复发少见。我们的研究发现，ALND 并未降低腋窝复发的发生或提高总生存率。目前尚不清楚哪些患者受益于腋窝清扫术。
