Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain.
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga, s/n, 08907, l'Hospitalet de Llobregat, Spain.
Breast Cancer Res Treat. 2024 Jul;206(1):131-141. doi: 10.1007/s10549-024-07274-1. Epub 2024 Apr 18.
In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies.
We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI).
The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985).
Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.
在临床淋巴结阴性（cN0）乳腺癌患者中，与新辅助化疗（NACT）前相比，更倾向于在 NACT 后进行前哨淋巴结活检（SLNB）。然而，这两种策略相关的生存结果仍研究不足。我们旨在比较两种策略的腋窝淋巴结清扫（ALND）率、无病生存率（DFS）和总生存率（OS）。
我们进行了一项回顾性观察性研究，共纳入 310 例患者。2006 年 12 月至 2014 年 4 月行 NACT 前 SLNB（107 例），2014 年 5 月至 2020 年 5 月行 NACT 后 SLNB（203 例）。应用逆概率治疗加权（IPTW）法使两组均衡。报告风险比（HR）和比值比（OR）及其 95%置信区间（95%CI）。
NACT 前 ALND 率为 29.9%，NACT 后为 7.4%（p<0.001），OR 为 5.35（95%CI 2.7-10.4）；p=0.002。随访 4 年后，NACT 后 SLNB 与较低的 DFS 风险相关，HR 0.42（95%CI 0.17-1.06）；p=0.066，OS 更好，HR 0.21（95%CI 0.07-0.67）；p=0.009。与 NACT 前 SLNB 相比，多变量分析的独立预后因素包括 NACT 前 SLNB，HR 3.095（95%CI 2.323-4.123）、NACT 临床无反应，HR 1.702（95%CI 1.012-2.861）和小肿瘤（cT1）高增殖指数，HR 1.889（95%CI 1.195-2.985）。
在 NACT 前行 SLNB 导致更多的 ALND，且对患者生存无益。这些发现支持在 cN0 乳腺癌患者中停止 NACT 前 SLNB 的做法。
