Vicini Elisa, Galimberti Viviana, Leonardi Maria Cristina, Kahler-Ribeiro-Fontana Sabrina, Polizzi Andrea, Petitto Salvatore, Pagan Eleonora, Bagnardi Vincenzo, Montagna Emilia, Cavallone Matteo, Caldarella Pietro, Intra Mattia, Veronesi Paolo
Division of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Department of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
Breast Cancer Res Treat. 2025 Apr;210(3):661-672. doi: 10.1007/s10549-024-07604-3. Epub 2025 Jan 8.
The use of neoadjuvant systemic therapy for primary breast cancer can achieve tumor shrinkage, enabling less invasive surgical treatments, such as breast-conserving surgery instead of mastectomy, and sentinel node biopsy instead of axillary dissection. In recent years, an increasing number of studies have explored the use of primary systemic therapy for occult breast cancer with axillary presentation. These studies suggest that a more conservative approach, involving targeted axillary surgery could be cautiously proposed for occult breast cancer after neoadjuvant chemotherapy in selected patients. In cases where a complete pathological response in the lymph nodes is achieved, there may also be the possibility to omit radiotherapy.
We retrospectively reviewed surgical interventions for carcinoma of unknown primary (CUP) syndrome with axillary presentation at the European Institute of Oncology from April 2004 to October 2022. Demographic and clinicopathological characteristics of the patients were collected and follow-up information has been updated.
A total of 114 patients who underwent axillary surgery for occult breast cancer were included. The 5-year disease-free survival was 74.5%, while overall survival was 88.5%. A total of 22.8% of patients underwent neoadjuvant treatment. Complete pathological response was achieved in 38.5%. Patients with complete nodal pathological response showed fewer events compared to patients with no complete pathological response after neoadjuvant treatment.
Although the sample size is limited, recent advances in breast cancer multimodal treatment indicate that targeted axillary surgery may be considered for the rare clinical presentation of occult breast cancer after neoadjuvant treatment.
Trial registration number UID 4184 24/07/2024 "retrospectively registered".
对原发性乳腺癌使用新辅助全身治疗可实现肿瘤缩小，从而使手术治疗的侵入性降低，例如采用保乳手术而非乳房切除术，以及前哨淋巴结活检而非腋窝淋巴结清扫术。近年来，越来越多的研究探讨了对出现腋窝表现的隐匿性乳腺癌使用原发性全身治疗的情况。这些研究表明，对于经过选择的患者，在新辅助化疗后，对于隐匿性乳腺癌可谨慎地采用更保守的方法，即进行靶向腋窝手术。在淋巴结实现完全病理缓解的情况下，也有可能省略放疗。
我们回顾性分析了2004年4月至2022年10月在欧洲肿瘤研究所对出现腋窝表现的不明原发癌（CUP）综合征进行的手术干预。收集了患者的人口统计学和临床病理特征，并更新了随访信息。
总共纳入了114例因隐匿性乳腺癌接受腋窝手术的患者。5年无病生存率为74.5%，总生存率为88.5%。共有22.8%的患者接受了新辅助治疗。38.5%的患者实现了完全病理缓解。与新辅助治疗后未实现完全病理缓解的患者相比，实现淋巴结完全病理缓解的患者出现的事件较少。
尽管样本量有限，但乳腺癌多模式治疗的最新进展表明，对于新辅助治疗后隐匿性乳腺癌这种罕见的临床表现，可考虑进行靶向腋窝手术。
试验注册号UID 4184 24/07/2024“回顾性注册”
