Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School Boston, MA, USA.
Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School Boston, MA, USA; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Am J Surg. 2024 Oct;236:115893. doi: 10.1016/j.amjsurg.2024.115893. Epub 2024 Aug 9.
Sentinel lymph node biopsy reduces morbidity in patients with clinically node-positive breast cancer who achieve axillary pathologic complete response following neoadjuvant therapy (NACT). De-escalation trials primarily addressed cN1 disease, with underrepresentation of cN2 disease. This study evaluates the role of de-escalation in patients with cN2 breast cancer.
A retrospective analysis of the National Cancer Database (2013-2020) included women over 18 with T1-2 invasive breast cancer and clinical N2 disease who received NACT followed by ALND or SLNB then ALND. The primary outcome was pathologic nodal status post-NACT.
Of 5852 cN2 patients treated, 18.15 % achieved ypN0, 0.97 % had isolated tumor cells, 19.14 % were ypN1, 49.64 % were ypN2, and 12.20 % were ypN3 following NACT. Achieving ypN0 was associated with pCR in the breast, HER2-positive and triple-negative receptor status, cT2 tumors, and younger age.
Despite some patients with cN2 disease achieving ypN0, most exhibited residual axillary disease post-NACT. These findings indicate that axillary de-escalation may not be feasible for most patients with cN2 disease, underscoring the importance of meticulous patient selection and assessment.
前哨淋巴结活检可降低接受新辅助化疗（NACT）后腋窝病理完全缓解的临床阳性淋巴结乳腺癌患者的发病率。降阶梯试验主要针对 cN1 疾病，而 cN2 疾病代表性不足。本研究评估了降阶梯策略在 cN2 乳腺癌患者中的作用。
对国家癌症数据库（2013-2020 年）进行回顾性分析，纳入接受 NACT 后行腋窝清扫术（ALND）或前哨淋巴结活检（SLNB）加 ALND 的 T1-2 浸润性乳腺癌且临床 N2 疾病的年龄大于 18 岁的女性患者。主要结局是 NACT 后的病理淋巴结状态。
5852 例 cN2 患者中，18.15%达到ypN0，0.97%有孤立肿瘤细胞，19.14%为 ypN1，49.64%为 ypN2，12.20%为 ypN3。达到 ypN0 与乳腺 pCR、HER2 阳性和三阴性受体状态、cT2 肿瘤和较年轻的年龄相关。
尽管一些 cN2 疾病患者达到了 ypN0，但大多数患者在 NACT 后仍存在腋窝残留疾病。这些发现表明，对于大多数 cN2 疾病患者，腋窝降阶梯可能不可行，这突显了对患者进行仔细选择和评估的重要性。
