新辅助治疗后达到病理完全缓解的临床 N2 期三阴性或 HER2 阳性乳腺癌患者行腋窝淋巴结清扫术是否必要？

Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy: Is it necessary?

机构信息

Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road, Zhengzhou, Henan Province, 450008, China.

Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.

出版信息

Breast. 2024 Feb;73:103671. doi: 10.1016/j.breast.2024.103671. Epub 2024 Jan 5.

DOI:10.1016/j.breast.2024.103671

PMID:38277714

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10832498/

Abstract

AIM

This study aims to identify suitable candidates for axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) among clinical N2 (cN2) triple-negative (TN) or HER2 positive (HER2+）breast cancer patients following neoadjuvant therapy（NAT）.

BACKGROUND

Despite the substantial axillary burden in cN2 breast cancer patients, high pathological response rates can be achieved with NAT in TN or HER2+ subtypes, thus enabling potential downstaging of axillary surgery.

METHODS

A retrospective analysis was conducted on data from the CSBrS-012 study, screening 709 patients with initial cN2, either HER2+ or TN subtype, from January 1, 2010 to December 31, 2020. The correlation between axillary pathologic complete response (pCR) (yPN0) and breast pCR was examined.

RESULTS

Among the 177 cN2 patients who achieved breast pCR through NAT, 138 (78.0 %) also achieved axillary pCR. However, in the 532 initial clinical N2 patients who did not achieve breast pCR, residual axillary lymph node metastasis persisted in 77.4 % (412/532) of cases. The relative risk of residual axillary lymph node metastasis in patients who did not achieve breast pCR was 12.4 (8.1-19.1), compared to those who did achieve breast pCR, P < 0.001.

CONCLUSION

For cN2 TN or HER2+ breast cancer patients who achieve breast pCR following NAT, consideration could be given to downstaging and performing an axillary SLNB or TAD.

摘要

目的

本研究旨在为新辅助治疗（NAT）后临床 N2（cN2）三阴性（TN）或人表皮生长因子受体 2 阳性（HER2+）乳腺癌患者识别适合进行腋窝前哨淋巴结活检（SLNB）或靶向腋窝解剖（TAD）的候选者。

背景

尽管 cN2 乳腺癌患者的腋窝负担很大，但在 TN 或 HER2+亚型中，NAT 可以实现较高的病理缓解率，从而使腋窝手术降级成为可能。

方法

对 2010 年 1 月 1 日至 2020 年 12 月 31 日 CSBrS-012 研究中初始 cN2 患者的资料进行回顾性分析，筛选出 HER2+或 TN 亚型的 709 例患者。研究考察了腋窝病理完全缓解（pCR）（ypN0）与乳腺 pCR 的相关性。

结果

在 177 例通过 NAT 实现乳腺 pCR 的 cN2 患者中，138 例（78.0%）也实现了腋窝 pCR。然而，在 532 例初始临床 N2 患者中，532 例未实现乳腺 pCR 的患者中，残留腋窝淋巴结转移仍存在于 77.4%（412/532）的病例中。未实现乳腺 pCR 的患者与实现乳腺 pCR 的患者相比，残留腋窝淋巴结转移的相对风险为 12.4（8.1-19.1），P<0.001。