Department of Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.
Department of Surgery, Chonnam National University Medical School & Chonnam National University Hospital, Gwang-ju, Republic of Korea.
Anticancer Res. 2024 Aug;44(8):3493-3500. doi: 10.21873/anticanres.17169.
BACKGROUND/AIM: This study aimed to identify the risk factors associated with non-sentinel lymph node (non-SLN) metastasis in case of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer with cN0 on preoperative exam, where the sentinel lymph node (SLN) is positive.
We conducted a retrospective review of medical records from the Chonnam National University Hwasun Hospital, spanning from January 2013 to January 2020, focusing on patients with HR+, HER2- breast cancer. Specifically, we collected the clinical and pathological data for those patients who underwent axillary lymph node dissection (ALND) due to positive SLN.
Among the 166 patients who underwent ALND after positive SLNs, median patient age was 52 years. Univariate analyses demonstrated a significant association between non-SLN metastasis and the number of positive SLNs (p=0.039), SLN positive ratio (p<0.001), and primary tumor size (p=0.018). Multivariate analysis revealed that an SLN ratio >0.55 (p=0.004, HR=3.007, 95% CI=1.427-6.335) was independently associated with non-SLN metastasis. However, neither the number of positive SLN nor primary tumor size showed associations with non-SLN metastases.
In patients with HR+, HER2- breast cancer who are cN0, completion of ALND should be considered when the positive SLN ratio is ≥0.55. This approach aims to provide the opportunity for survival benefit through additional adjuvant therapy or to contribute to de-escalation of unnecessary surgery.
背景/目的：本研究旨在确定激素受体（HR）阳性、人表皮生长因子受体 2（HER2）阴性乳腺癌患者术前 cN0 且前哨淋巴结（SLN）阳性时，与非前哨淋巴结（non-SLN）转移相关的危险因素。
我们对 2013 年 1 月至 2020 年 1 月期间在韩国全南大学丽水医院接受治疗的 HR+、HER2-乳腺癌患者的病历进行了回顾性分析，重点关注接受 SLN 阳性患者的腋窝淋巴结清扫术（ALND）的患者。
在 166 例 SLN 阳性后接受 ALND 的患者中，中位患者年龄为 52 岁。单因素分析表明，non-SLN 转移与阳性 SLN 数量（p=0.039）、SLN 阳性率（p<0.001）和原发肿瘤大小（p=0.018）之间存在显著相关性。多因素分析显示，SLN 比值>0.55（p=0.004，HR=3.007，95%CI=1.427-6.335）与 non-SLN 转移独立相关。然而，阳性 SLN 数量和原发肿瘤大小均与 non-SLN 转移无关。
在 HR+、HER2-乳腺癌 cN0 患者中，当 SLN 阳性率≥0.55 时，应考虑完成 ALND。这一方法旨在通过额外的辅助治疗提供生存获益的机会，或有助于降低不必要手术的风险。
