Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China.
Department of Biophysics, School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University Health Science Center, No.76 Western Yanta Road, Xi'an, Shaanxi, 710061, China.
Clin Breast Cancer. 2024 Jun;24(4):e232-e243.e1. doi: 10.1016/j.clbc.2024.01.012. Epub 2024 Jan 24.
The survival benefit of axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB) combined with radiation, and ALND combined with radiation remains unclear in breast cancer (BC) patients with 1-2 metastatic sentinel lymph nodes (SLNs). This study aims to rigorously evaluate the prognostic impact of these axillary evaluation modalities on BC patients with varying T-stages and to construct a survival prediction nomogram.
Following screening for inclusion and exclusion criteria, data pertaining to BC patients were extracted from the SEER database. Overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Kaplan-Meier curves and Cox proportional hazards model among patients with different stages who underwent various axillary evaluation modalities. A nomogram was constructed to predict the probability of OS and BCSS.
A total of 20,283 patients were included, comprising 9626 who underwent breast-conserving surgery (BCS) and 10,657 who underwent mastectomy. In the T stage stratified analysis, both BCS and mastectomy groups exhibited superior OS and BCSS with ALND compared to SLNB combined with radiation. Further, ALND combined with radiation improved OS. However, for T stages, patients treated with ALND experienced similar or worse survival compared to those treated with SLNB combined with radiation. The calibration curve and C-index (0.746-0.794) of the nomogram demonstrated the efficacy of the survival prediction model.
In T BC patients with 1-2 metastatic SLNs, SLNB combined with radiation is a safe alternative to ALND. Conversely, for T patients, ALND combined with radiation may offer a preferable choice.
在 1-2 个转移性前哨淋巴结（SLN）的乳腺癌（BC）患者中，腋窝淋巴结清扫术（ALND）、SLNB 联合放疗以及 ALND 联合放疗的生存获益仍不清楚。本研究旨在严格评估这些腋窝评估方式对不同 T 分期的 BC 患者的预后影响，并构建生存预测列线图。
在筛选纳入和排除标准后，从 SEER 数据库中提取了 BC 患者的数据。在接受不同腋窝评估方式的不同分期患者中，使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估总生存（OS）和乳腺癌特异性生存（BCSS）。构建列线图预测 OS 和 BCSS 的概率。
共纳入 20283 例患者，其中 9626 例接受保乳手术（BCS），10657 例接受乳房切除术。在 T 分期分层分析中，BCS 和乳房切除术组均显示 ALND 比 SLNB 联合放疗具有更好的 OS 和 BCSS。此外，ALND 联合放疗可改善 OS。然而，对于 T 分期，接受 ALND 治疗的患者与接受 SLNB 联合放疗的患者相比，生存情况相似或更差。该列线图的校准曲线和 C 指数（0.746-0.794）表明了生存预测模型的有效性。
在 1-2 个转移性 SLN 的 T 期 BC 患者中，SLNB 联合放疗是 ALND 的安全替代方案。相反，对于 T 期患者，ALND 联合放疗可能是更好的选择。
