Grant Katherine, Po Xiang Yuen, Tiong Leong
Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2024 Dec;94(12):2159-2164. doi: 10.1111/ans.19313. Epub 2024 Nov 27.
Investigate incidence and identify predictors of axillary lymph node metastases in early breast cancer in women >74 years Australia and New Zealand to inform decision making about sentinel lymph node (SLN) biopsy in this population.
Retrospective review of invasive breast cancer in women in Australia and New Zealand between 2010 and 2022 using BreastSurgANZ Quality Audit Database. Data included patient demographics, tumour characteristics, surgery type, axillary nodal status and adjuvant therapy. Descriptive analysis of incidence of axillary nodal metastases and use of adjuvant therapy in various patient and tumour groups was performed, followed by statistical analysis using multivariate logistic regression to identify predictors of axillary nodal positivity and correlation between nodal status and prescription of adjuvant therapy.
Review of 127 436 cases of invasive breast cancer, 17 599 cases >74 years. Two thirds of the overall population and in those >74 years were node negative. In patients >74 years with grade 1-2, T1a-b cancers, ER+/HER2- 94% were node negative. Patient age, tumour size, grade and biomarker profile correlated with axillary nodal status and analysis of adjuvant therapy revealed significant correlation between nodal stage and adjuvant radiotherapy, chemotherapy and endocrine therapy.
A total of 94% of patients >74 years with T1a/b, ER positive HER2 negative breast cancer were node negative. Nodal status significantly influences adjuvant treatment in this patient group and therefore, we recommend clinicians consider tumour factors and patient fitness in their decision making about SLN biopsy in the elderly population with hormone receptor positive early breast cancer.
调查澳大利亚和新西兰74岁以上女性早期乳腺癌腋窝淋巴结转移的发生率，并确定其预测因素，以为该人群前哨淋巴结活检的决策提供依据。
利用澳大利亚和新西兰乳腺外科质量审核数据库，对2010年至2022年间澳大利亚和新西兰女性浸润性乳腺癌进行回顾性研究。数据包括患者人口统计学信息、肿瘤特征、手术类型、腋窝淋巴结状态和辅助治疗。对各患者和肿瘤组腋窝淋巴结转移发生率及辅助治疗的使用情况进行描述性分析，随后采用多因素逻辑回归进行统计分析，以确定腋窝淋巴结阳性的预测因素以及淋巴结状态与辅助治疗处方之间的相关性。
回顾了127436例浸润性乳腺癌病例，其中17599例患者年龄大于74岁。总体人群以及74岁以上人群中有三分之二淋巴结为阴性。在74岁以上患有1-2级、T1a-b期癌症、雌激素受体阳性/人表皮生长因子受体2阴性的患者中，94%淋巴结为阴性。患者年龄、肿瘤大小、分级和生物标志物谱与腋窝淋巴结状态相关，辅助治疗分析显示淋巴结分期与辅助放疗、化疗和内分泌治疗之间存在显著相关性。
74岁以上患有T1a/b期、雌激素受体阳性、人表皮生长因子受体2阴性乳腺癌的患者中，共有94%淋巴结为阴性。淋巴结状态对该患者组的辅助治疗有显著影响，因此，我们建议临床医生在对激素受体阳性早期乳腺癌老年人群进行前哨淋巴结活检决策时，考虑肿瘤因素和患者健康状况。
