Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2024 Dec;31(13):8821-8828. doi: 10.1245/s10434-024-16124-9. Epub 2024 Sep 6.
Axillary staging in early-stage breast cancer can impact adjuvant treatment options but also has associated morbidity. The incidence of pathologic nodal positivity (pN+) in patients with microinvasive or T1a disease is poorly characterized and the value of sentinel node biopsy remains controversial.
Women with cN0 and pathologic microinvasive or T1a cancer who underwent upfront surgery were identified from the National Cancer Database. Pathologic nodal stage at the time of surgery was the primary outcome. Multivariable logistic modeling was used to assess predictors of pN+.
Overall, 141,840 women were included; 139,206 had pathologic node-negative (pN0) disease and 2634 had pN+ disease. Rates of pN+ disease differed by receptor status, with the highest rates in hormone receptor-negative/human epidermal growth factor receptor 2-positive (HR-/HER2+) disease compared with triple-negative breast cancer (TNBC), HR-positive/HER2-negative (HR+/HER2-), and triple positive breast cancer. Rates of pN+ were also higher with lobular histology compared with ductal histology. Multivariable analysis demonstrated that compared with White women, Black women had higher odds of pN+ disease, and compared with women <50 years of age, women >70 years of age had higher odds of pN+ disease. Compared with women with HR+/HER2- disease, women with TNBC, triple-positive breast cancer, and HR-/HER2+ all had lower odds, and women with invasive lobular disease had higher odds compared with women with invasive ductal disease. Women with significant comorbidities also had higher odds of node positivity.
Over 90% of patients with clinically node-negative, microinvasive and T1a breast cancer remain pathologically node-negative following axillary staging. However, higher rates of nodal disease were found among Black patients, older patients, and patients with lobular cancer and significant comorbidities.
早期乳腺癌的腋窝分期会影响辅助治疗方案，但也会带来相关的发病率。微浸润或 T1a 疾病患者的病理性淋巴结阳性（pN+）发生率描述不足，前哨淋巴结活检的价值仍存在争议。
从国家癌症数据库中确定了接受直接手术治疗且临床淋巴结阴性、存在微浸润或 T1a 癌的女性患者。手术时的病理性淋巴结分期是主要结局。采用多变量逻辑模型评估 pN+的预测因素。
共纳入 141840 名女性；139206 名患者的病理淋巴结阴性（pN0），2634 名患者的病理淋巴结阳性（pN+）。pN+疾病的发生率因受体状态而异，激素受体阴性/人表皮生长因子受体 2 阳性（HR-/HER2+）疾病的发生率最高，与三阴性乳腺癌（TNBC）、激素受体阳性/人表皮生长因子受体 2 阴性（HR+/HER2-）和三阳性乳腺癌相比。与导管组织学相比，小叶组织学的 pN+发生率更高。多变量分析表明，与白人女性相比，黑人女性 pN+疾病的发病风险更高，与<50 岁的女性相比，>70 岁的女性 pN+疾病的发病风险更高。与 HR+/HER2-疾病的女性相比，TNBC、三阳性乳腺癌和 HR-/HER2+的女性发病风险更低，浸润性小叶癌的女性发病风险更高与浸润性导管癌的女性相比。合并症较多的女性也有更高的淋巴结阳性几率。
超过 90%的临床淋巴结阴性、微浸润和 T1a 乳腺癌患者在接受腋窝分期后病理淋巴结仍为阴性。然而，黑人患者、老年患者、小叶癌患者和合并症较多的患者淋巴结疾病的发生率更高。
