School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
Ann Surg Oncol. 2024 Jan;31(1):335-343. doi: 10.1245/s10434-023-14407-1. Epub 2023 Oct 13.
In 2016, the Choosing Wisely campaign recommended against routine sentinel lymph node biopsy (SLNB) in women ≥ 70 years old diagnosed with early-stage hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer. No distinction is made between luminal A and luminal B phenotypes, despite luminal B being considered more aggressive. This study evaluates the effect of SLNB on oncologic outcomes in HER2- luminal B versus luminal A breast cancer.
We performed an IRB-approved, single institution, retrospective cohort study from 2010 to 2020 of women aged ≥ 70 years with clinically node negative, HR+ breast cancer undergoing definitive surgical treatment. Luminal status was defined by gene expression panel testing, Ki67%, and/or pathologic grading. Primary endpoints included locoregional recurrence (LRR), disease free survival (DFS), and overall survival (OS).
SLNB did not correlate with significant differences in LRR in luminal A (p = 0.92) or luminal B (p = 0.96) disease. SLNB correlated with improved DFS (p < 0.01) and OS (p < 0.001) in luminal A disease, but not in luminal B disease (DFS p = 0.73; OS p = 0.36). On multivariate analysis, age (HR = 1.17; p < 0.01) and tumor size (HR = 1.03; p < 0.05) were associated with DFS, while SLNB was not (p = 0.71). Luminal status (HR = 0.52, p < 0.05), age (HR = 1.15, p < 0.01), and comorbidities (HR = 1.35, p < 0.05) were associated with OS, but not SLNB (p = 0.71).
Our results suggest that SLNB may be safely omitted in patients aged ≥ 70 years with luminal B disease given similar LRR in luminal A disease. Our findings suggest that DFS and OS are driven by tumor biology, patient age, and comorbidities rather than receipt of SLNB.
2016 年，“明智选择”运动建议不常规进行 70 岁以上诊断为早期激素受体阳性（HR+）、HER2 阴性（HER2-）乳腺癌的女性的前哨淋巴结活检（SLNB）。尽管 luminal B 型被认为更具侵袭性，但在 luminal A 和 luminal B 表型之间没有区别。本研究评估了 SLNB 对 HER2- luminal B 型与 luminal A 型乳腺癌患者肿瘤学结局的影响。
我们对 2010 年至 2020 年间年龄≥70 岁、临床淋巴结阴性、HR+乳腺癌接受确定性手术治疗的女性进行了一项经机构审查委员会批准的单中心回顾性队列研究。Luminal 状态通过基因表达谱检测、Ki67%和/或病理分级来定义。主要终点包括局部区域复发（LRR）、无病生存率（DFS）和总生存率（OS）。
SLNB 与 luminal A（p=0.92）或 luminal B（p=0.96）疾病的 LRR 无显著差异相关。SLNB 与 luminal A 疾病的 DFS（p<0.01）和 OS（p<0.001）相关改善，但与 luminal B 疾病无关（DFS p=0.73；OS p=0.36）。多变量分析显示，年龄（HR=1.17；p<0.01）和肿瘤大小（HR=1.03；p<0.05）与 DFS 相关，而 SLNB 无关（p=0.71）。Luminal 状态（HR=0.52，p<0.05）、年龄（HR=1.15，p<0.01）和合并症（HR=1.35，p<0.05）与 OS 相关，但与 SLNB 无关（p=0.71）。
我们的结果表明，对于 luminal B 型疾病的≥70 岁患者，SLNB 可能可以安全省略，因为 luminal A 型疾病的 LRR 相似。我们的研究结果表明，DFS 和 OS 受肿瘤生物学、患者年龄和合并症的驱动，而不是 SLNB 的接受情况。
