So Alycia, Yi Min, Simons Janine M, Kuerer Henry M, Caudle Abigail, DeSnyder Sarah M, Bedrosian Isabelle, Nead Kevin T, Chavez-MacGregor Mariana, Teshome Mediget, Hunt Kelly K
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands.
Ann Surg Oncol. 2025 Feb;32(2):922-930. doi: 10.1245/s10434-024-16382-7. Epub 2024 Oct 23.
Trials evaluating omission of axillary dissection (ALND) in patients with cN0 breast cancer with positive sentinel lymph nodes (SLNs) have excluded neoadjuvant chemotherapy (NACT). It remains unclear whether the data can be extrapolated to cN0 patients undergoing NACT. This study sought to identify factors associated with positive SLNs and additional disease on ALND in cT1-2N0 disease after NACT.
The authors queried their database for cT1-2N0 patients treated with NACT followed by SLN biopsy from 1996 to 2022. Physical examination and ultrasound determined clinical nodal status. Multivariable logistic regression identified factors associated with positive SLNs and disease on ALND.
Of 1930 patients, 234 (12.1%) had positive SLNs. Positive SLNs were predicted by hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) status (odds ratio [OR] 2.5; p < 0.0001), lobular histology (OR 1.8; p = 0.007), multifocality (OR 2; p = 0.001), grade 1 tumors (OR 2.5; p = 0.002), and cT2 category (OR 1.9; p = 0.004). Of the 234 patients with positive SLNs and known SLN metastasis size, 148 (63.2%) underwent ALND, and 39 (26.4%) had additional positive nodes. Increasing patient age predicted disease on ALND (OR 1.03; p = 0.02). No additional positive nodes on ALND were identified in patients with only isolated tumor cells compared with 12.3% who had micrometastases and 37.6% who had macrometastases (p = 0.01). During a 5-year median follow-up period of the SLN-positive patients, three (1.3%) experienced axillary recurrence and two of the three underwent ALND at the initial surgery with no additional positive nodes.
In cT1-2N0 breast cancer, HR+/HER2- status, lobular histology, multifocality and cT2 category predicted positive SLNs after NACT. Older age predicted positive nodes on ALND. Patients with positive SLNs had low axillary recurrence rates. These findings support investigation into omission of ALND in cN0 breast cancer and a low volume of SLN disease after NACT.
评估cN0乳腺癌且前哨淋巴结（SLN）阳性患者省略腋窝淋巴结清扫（ALND）的试验排除了新辅助化疗（NACT）。目前尚不清楚这些数据是否可以外推至接受NACT的cN0患者。本研究旨在确定NACT后cT1-2N0疾病中与SLN阳性及ALND发现额外疾病相关的因素。
作者查询其数据库中1996年至2022年接受NACT后行SLN活检的cT1-2N0患者。体格检查和超声确定临床淋巴结状态。多变量逻辑回归确定与SLN阳性及ALND发现疾病相关的因素。
1930例患者中，234例（12.1%）SLN阳性。激素受体阳性（HR+）/人表皮生长因子受体2阴性（HER2-）状态（比值比[OR]2.5；p<0.0001）、小叶组织学（OR 1.8；p = 0.007）、多灶性（OR 2；p = 0.001）、1级肿瘤（OR 2.5；p = 0.002）和cT2分类（OR 1.9；p = 0.004）可预测SLN阳性。在234例SLN阳性且已知SLN转移大小的患者中，148例（63.2%）接受了ALND，39例（26.4%）有额外阳性淋巴结。患者年龄增加可预测ALND发现疾病（OR 1.03；p = 0.02）。与有微转移的患者（12.3%）和有宏转移的患者（37.6%）相比，仅发现孤立肿瘤细胞的患者ALND未发现额外阳性淋巴结（p = 0.01）。在SLN阳性患者的5年中位随访期内，3例（1.3%）发生腋窝复发，其中2例在初次手术时接受了ALND，未发现额外阳性淋巴结。
在cT1-2N0乳腺癌中，HR+/HER2-状态、小叶组织学、多灶性和cT2分类可预测NACT后SLN阳性。年龄较大可预测ALND发现阳性淋巴结。SLN阳性患者腋窝复发率较低。这些发现支持对cN0乳腺癌省略ALND以及NACT后低负荷SLN疾病进行研究。
