Zhang Maoquan, Sun Yingming, Wu Huasheng, Xiao Jian, Chen Wenxin, Wang Hebin, Yang Binglin, Luo Huatian
Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China.
Department of Medical and Radiation Oncology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, Fujian, China.
Front Oncol. 2024 Jan 24;14:1319981. doi: 10.3389/fonc.2024.1319981. eCollection 2024.
Sentinel lymph node biopsy (SLNB) in breast cancer patients with positive clinical axillary lymph nodes (cN1+) remains a topic of controversy. The aim of this study is to assess the influence of various axillary and breast surgery approaches on the survival of cN1+ breast cancer patients who have responded positively to neoadjuvant therapy (NAT).
Patients diagnosed with pathologically confirmed invasive ductal carcinoma of breast between 2010 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. To mitigate confounding bias, propensity score matching (PSM) analysis was employed. Prognostic factors for both overall survival (OS) and breast cancer-specific survival (BCSS) were evaluated through COX regression risk analysis. Survival curves were generated using the Kaplan-Meier method. Furthermore, cumulative incidence and independent prognostic factors were assessed using a competing risk model.
The PSM analysis matched 4,890 patients. Overall survival (OS) and BCSS were slightly worse in the axillary lymph node dissection (ALND) group (HR = 1.10, 95% CI 0.91-1.31, p = 0.322 vs. HR = 1.06, 95% CI 0.87-1.29, p = 0.545). The mastectomy (MAST) group exhibited significantly worse OS and BCSS outcomes (HR = 1.25, 95% CI 1.04-1.50, p = 0.018 vs. HR = 1.37, 95% CI 1.12-1.68, p = 0.002). The combination of different axillary and breast surgery did not significantly affect OS (p = 0.083) but did have a significant impact on BCSS (p = 0.019). Competing risk model analysis revealed no significant difference in the cumulative incidence of breast cancer-specific death (BCSD) in the axillary surgery group (Grey's test, p = 0.232), but it showed a higher cumulative incidence of BCSD in the MAST group (Grey's test, p = 0.001). Multivariate analysis demonstrated that age ≥ 70 years, black race, T3 stage, ER-negative expression, HER2-negative expression, and MAST were independent prognostic risk factors for both OS and BCSS (all p < 0.05).
For cN1+ breast cancer patients who respond positive to NAT, the optimal surgical approach is combining breast-conserving surgery (BCS) with SLNB. This procedure improves quality of life and long-term survival outcomes.
对于临床腋窝淋巴结阳性（cN1+）的乳腺癌患者，前哨淋巴结活检（SLNB）仍是一个存在争议的话题。本研究的目的是评估各种腋窝和乳房手术方式对新辅助治疗（NAT）反应阳性的cN1+乳腺癌患者生存的影响。
从监测、流行病学和最终结果（SEER）数据库中识别出2010年至2020年间病理确诊为乳腺浸润性导管癌的患者。为减轻混杂偏倚，采用倾向评分匹配（PSM）分析。通过COX回归风险分析评估总生存（OS）和乳腺癌特异性生存（BCSS）的预后因素。使用Kaplan-Meier方法生成生存曲线。此外，使用竞争风险模型评估累积发病率和独立预后因素。
PSM分析匹配了4890例患者。腋窝淋巴结清扫（ALND）组的总生存（OS）和BCSS略差（HR = 1.10，95%CI 0.91 - 1.31，p = 0.322 vs. HR = 1.06，95%CI 0.87 - 1.29，p = 0.545）。乳房切除术（MAST）组的OS和BCSS结果显著更差（HR = 1.25，95%CI 1.04 - 1.50，p = 0.018 vs. HR = 1.37，95%CI 1.12 - 1.68，p = 0.002）。不同腋窝和乳房手术的联合对OS没有显著影响（p = 0.083），但对BCSS有显著影响（p = 0.019）。竞争风险模型分析显示腋窝手术组乳腺癌特异性死亡（BCSD）的累积发病率无显著差异（Grey检验，p = 0.232），但MAST组的BCSD累积发病率更高（Grey检验，p = 0.001）。多因素分析表明，年龄≥70岁、黑人种族、T3期、雌激素受体（ER）阴性表达、人表皮生长因子受体2（HER2）阴性表达和MAST是OS和BCSS的独立预后危险因素（所有p < 0.05）。
对于对NAT反应阳性的cN1+乳腺癌患者，最佳手术方式是保乳手术（BCS）联合SLNB。该手术可提高生活质量和长期生存结果。
