Zapletal Ondřej, Žatecký Jan, Gabrielová Lucie, Selingerová Iveta, Holánek Miloš, Burkoň Petr, Coufal Oldřich
Department of Surgical Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic.
Department of Surgical Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
Cancers (Basel). 2025 Jan 8;17(2):178. doi: 10.3390/cancers17020178.
In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment.
A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical-pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records.
ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma ( = 13, 29.5%), locally advanced carcinoma ( = 5, 11.4%), occult carcinoma ( = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) ( = 8, 18.2%).
Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.
在当前靶向腋窝清扫术（TAD）的时代，仍有一些病例需要进行腋窝淋巴结清扫术（ALND），但组织病理学检查证实淋巴结转移灶消退（ypN0）。在这种情况下，ALND可能代表不必要的过度治疗。
基于一个前瞻性维护的数据库，在综合癌症中心进行了一项回顾性研究。选择2020年至2023年间接受新辅助化疗（NAC）后进行手术的患者，特别是那些NAC后直接需要进行ALND的患者。随后，比较ypN0病例和持续性转移（ypN+）病例的临床病理特征。从病历中提取ypN0病例中需要进行ALND的原因。
117例患者中有118例需要进行ALND，其中44例（37%）观察到ypN0。炎性癌（68%）、非腔面HER2阳性表型（76%）、原发肿瘤组织病理学消退（76%）或仅ypTis非浸润成分持续存在（67%）的癌中ypN0病例明显更多。ypN0病例中进行ALND的典型原因包括炎性癌（n = 13，29.5%）、局部晚期癌（n = 5，11.4%）、隐匿性癌（n = 2，4.5%）或NAC后超声检查发现持续性淋巴结肿大，特别是在HER2阳性和三阴性乳腺癌（TNBC）肿瘤表型中（n = 8，18.2%）。
通过真实世界证据数据分析，确定了接受NAC治疗的乳腺癌患者亚组，他们可能在腋窝接受手术过度治疗。这些患者包括炎性癌、局部晚期癌、隐匿性癌患者，或NAC后超声检查发现持续性淋巴结肿大的患者，特别是在HER2阳性和TNBC肿瘤表型中。
