Cabioglu Neslihan, Karanlik Hasan, Igci Abdullah, Muslumanoglu Mahmut, Gulcelik Mehmet Ali, Uras Cihan, Kocer Havva Belma, Trabulus Didem Can, Ozkurt Enver, Cakmak Guldeniz Karadeniz, Tukenmez Mustafa, Bademler Suleyman, Yildirim Nilufer, Akgul Gökhan Giray, Sen Ebru, Senol Kazim, Emiroglu Selman, Citgez Bulent, Ersoy Yeliz Emine, Dag Ahmet, Zengel Baha, Basaran Gul, Kara Halil, Dilege Ece, Ugurlu M Umit, Celik Atilla, Ilgun Serkan, Bolukbasi Yasemin, Karaman Niyazi, Sakman Gürhan, Ozbas Serdar, Kilic Halime Gul, Polat Ayfer Kamali, Ozemir Ibrahim Ali, Kilic Berkay, Altınok Ayse, Varol Ecenur, Dogan Lutfi, Akcan Alper, Ozcinar Beyza, Zer Leyla, Soyder Aykut, Velidedeoglu Mehmet, Erozgen Fazilet, Goktepe Berk, Dogan Mutlu, Kebudi Abut, Yigit Banu, Celik Burak, Yormaz Serdar, Arici Cumhur, Agcaoglu Orhan, Sevinc Ali Ibrahim, Atahan M Kemal, Valiyeva Vafa, Baran Elif, Aljorani Israa, Utkan Zafer, Yeniay Levent, Kivilcim Taner, Soran Atilla, Aydiner Adnan, Ibis Kamuran, Ozmen Vahit
Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Türkiye.
Ann Surg Oncol. 2025 Feb;32(2):952-966. doi: 10.1245/s10434-024-16472-6. Epub 2024 Dec 2.
This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC).
The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC.
A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0.
The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.
本研究旨在确定新辅助化疗（NAC）后接受前哨淋巴结活检（SLNB）的cN+患者复发和预后不良的预测因素。
回顾性多中心“MF18 - 02”研究和前瞻性多中心队列登记试验“MF18 - 03”（NCT04250129）纳入了cT1 - 4N1 - 3M0且NAC后行SLNB和/或腋窝淋巴结清扫（ALND）的患者。
共研究了2407例cN+患者，这些患者在NAC后达到cN0状态并随后接受了SLNB。大多数患者为cT1 - 2（79.1%）和N1（80.7%）。中位随访时间41个月后，局部区域复发率和腋窝复发（AR）率分别为1.83%和0.37%。仅行SLNB/靶向腋窝清扫组（n = 1470）和ALND组（n = 937）之间在局部区域复发率或AR率上未观察到显著差异。与AR显著相关的因素包括年龄小于45岁、乳腺非病理完全缓解（非pCR）以及非腔面病理类型。局部区域复发与非腔面或HER2(+)病理类型、乳腺非pCR以及ALND有关。无病生存（DFS）的不良预后因素包括cT3 - T4、乳腺无pCR（非pCR）、ypN(+)以及非腔面病理类型。ypN0、ypN孤立肿瘤细胞、ypN微转移和ypN1组之间在DFS或疾病特异性生存（DSS）率上未发现显著差异。然而，将ypN2或ypN3疾病与ypN0进行比较时，观察到DFS和DSS率显著降低。
目前的大型登记数据表明，年龄较小（<45岁）、具有非腔面病理类型以及乳腺仅部分缓解的患者更容易发生腋窝和局部区域复发。
