Man V, Kwong A
Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China.
Hong Kong Med J. 2024 Apr;30(2):139-146. doi: 10.12809/hkmj2210286. Epub 2024 Mar 25.
The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial resulted in de-escalation of axillary surgery among early-stage breast cancer patients with low-volume sentinel lymph node (SLN) disease undergoing breast-conserving surgery and radiation therapy. Nevertheless, the mastectomy rate in the Chinese population remains high. This study compared the clinical characteristics of the ACOSOG Z0011-eligible cohort with SLN-positive breast cancer patients in Hong Kong.
This retrospective analysis of a prospectively maintained database at a university-affiliated breast cancer centre in Hong Kong was performed from June 2014 to May 2019. The database included all patients with clinical tumour (T) stage T1 or T2 invasive breast carcinoma, no palpable adenopathy, one or two positive SLNs on histological examination, and no prior neoadjuvant systemic treatment. Comparisons were made between the mastectomy and breast-conserving treatment groups in our cohort, along with the sentinel-alone arm in the ACOSOG Z0011 trial.
One hundred and seventy-one patients met the inclusion criteria: 112 underwent mastectomy and 59 underwent breast-conserving treatment. Our mastectomy group had higher prevalences of T2 tumours (P<0.001), lymphovascular invasion (P<0.001), and SLN macrometastases (P=0.004) compared with the ACOSOG Z0011 cohort. However, in our patient population, mean pathological size slightly differed between the mastectomy and breast-conserving treatment groups (2.2 cm vs 1.8 cm; P=0.005). Other histopathological features were similar.
This study demonstrated that clinicopathological features were comparable between SLN-positive breast cancer patients undergoing mastectomy and those undergoing breast-conserving treatment. Low-risk SLN-positive mastectomy patients may safely avoid completion axillary lymph node dissection.
美国外科医师学会肿瘤学组（ACOSOG）Z0011试验使得接受保乳手术和放射治疗且前哨淋巴结（SLN）转移灶数量少的早期乳腺癌患者的腋窝手术降级。然而，中国人群的乳房切除术率仍然很高。本研究比较了符合ACOSOG Z0011标准的队列与香港SLN阳性乳腺癌患者的临床特征。
对香港一所大学附属乳腺癌中心前瞻性维护的数据库进行回顾性分析，时间跨度为2014年6月至2019年5月。该数据库纳入了所有临床肿瘤（T）分期为T1或T2的浸润性乳腺癌患者，无可触及的腺病，组织学检查发现一或两个SLN阳性，且未接受过新辅助全身治疗。对我们队列中的乳房切除术组和保乳治疗组以及ACOSOG Z0011试验中的仅前哨淋巴结清扫组进行了比较。
171例患者符合纳入标准：112例行乳房切除术，59例行保乳治疗。与ACOSOG Z0011队列相比，我们的乳房切除术组T2肿瘤（P<0.001）、淋巴管浸润（P<0.001）和SLN大转移灶（P=0.004）的患病率更高。然而，在我们的患者群体中，乳房切除术组和保乳治疗组的平均病理大小略有差异（2.2 cm对1.8 cm；P=0.005）。其他组织病理学特征相似。
本研究表明，接受乳房切除术的SLN阳性乳腺癌患者与接受保乳治疗的患者的临床病理特征具有可比性。低风险的SLN阳性乳房切除术患者可以安全地避免完成腋窝淋巴结清扫。
