LaBella M, Lile-King R E, Agala C B, Spanheimer P M, Ollila D W, Gallagher K K, Selfridge J M
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Surgical Oncology and Endocrine Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Suite 1148, Chapel Hill, NC, 27599-7213, USA.
Breast Cancer Res Treat. 2025 Jan;209(2):367-374. doi: 10.1007/s10549-024-07500-w. Epub 2024 Oct 13.
Occult Primary Breast Cancer (OPBC) is a rare clinical condition in which breast cancer is located within the axillary lymph nodes, but no primary tumor is identified in the breast. We evaluated trends of neoadjuvant chemotherapy (NAC) use and subsequent axillary procedures in OPBC as well as outcomes for these patients.
The National Cancer Database was used to identify adult women with cT0N1-3M0 breast cancer between 2012 to 2021 that underwent axillary lymph node surgery. Kaplan-Meier curves were used to evaluate survival between groups.
2759 patients met inclusion criteria. 86.2% underwent ALND alone in 2012, and this decreased to 65.6% in 2021. 4.7% underwent SLNB alone in 2012 and this increased to 16.2% in 2021 (p < 0.001). For patients who had undergone NAC, 46.4% of ALND patients had nodal pathologic complete response (nPCR), compared to 42.7% of SLNB + ALND and 66.4% of SLNB only patients. For patients with nPCR, there was no difference in overall survival (OS) between ALND, SLNB + ALND, and SLNB alone groups (p = 0.9912).
Most OPBC patients were treated with ALND, with a modest increase towards SLNB use during the study period. There was no difference in OS with respect to axillary surgical procedure in our population for those with nPCR after NAC. This suggests that for carefully selected OPBC patients with an excellent clinical response to NAC and negative SLNB, omission of ALND may be considered.
隐匿性原发性乳腺癌（OPBC）是一种罕见的临床病症，即乳腺癌位于腋窝淋巴结内，但在乳腺中未发现原发性肿瘤。我们评估了OPBC患者新辅助化疗（NAC）的使用趋势、随后的腋窝手术情况以及这些患者的预后。
利用国家癌症数据库识别2012年至2021年间接受腋窝淋巴结手术的cT0N1 - 3M0成年女性乳腺癌患者。采用Kaplan - Meier曲线评估组间生存率。
2759例患者符合纳入标准。2012年，86.2%的患者仅接受了腋窝淋巴结清扫术（ALND），到2021年这一比例降至65.6%。2012年，4.7%的患者仅接受了前哨淋巴结活检（SLNB），到2021年这一比例增至16.2%（p < 0.001）。对于接受NAC的患者，ALND患者中有46.4%达到淋巴结病理完全缓解（nPCR），而SLNB + ALND患者为42.7%，仅接受SLNB的患者为66.4%。对于达到nPCR的患者，ALND组、SLNB + ALND组和仅SLNB组之间的总生存期（OS）没有差异（p = 0.9912）。
大多数OPBC患者接受了ALND治疗，在研究期间SLNB的使用略有增加。在我们的研究人群中，对于NAC后达到nPCR的患者，腋窝手术方式对OS没有差异。这表明，对于精心挑选的、对NAC有良好临床反应且SLNB阴性的OPBC患者，可以考虑省略ALND。
