Cabıoğlu Neslihan, Karanlık Hasan, Özmen Vahit, Tükenmez Mustafa, İğci Abdullah, Aytin Yusuf E, Köksal Hande, Mutlu Halime, Bademler Süleyman, Uras Cihan, Dülgeroğlu Onur, Özkurt Enver, Emiroğlu Selman, Müslümanoğlu Mahmut, Yıldırım Nilüfer, Sezer Atakan, Çakmak Güldeniz Karadeniz, Balbaloğlu Hakan, Zihni İsmail, Güllüoğlu Bahadır M
Department of General Surgery, Breast Unit, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Türkiye.
Department of Surgical Oncology, Institute of Oncology, Istanbul University, İstanbul, Türkiye.
Clin Breast Cancer. 2025 Feb 8. doi: 10.1016/j.clbc.2025.02.002.
Randomized trials including ACOSOG Z0011 and SENOMAC mostly included patients with hormone receptor-positive breast cancer, but a limited number of patients with aggressive tumor biology. Therefore, we assessed the oncological safety of omitting axillary dissection in patients with SLN-positive HER2-positive or triple-negative breast cancer at upfront surgery.
This retrospective cohort study included patients with clinically node-negative HER2-positive and triple-negative breast cancer who had sentinel lymph node biopsy (SLNB) alone with pN+ disease. Almost all patients (97.5%) received nodal irradiation.
Between 2015 and 2020, 118 patients with HER2-positive (n = 79, 67%) and triple-negative (n = 39, 33%) tumors were included in the study from 8 centers. Of those, 94.9% were cT1-2 and 72% underwent breast-conserving surgery. Most patients (n = 98, 83.1%) had 1 metastatic sentinel lymph node. Among those with involved sentinel lymph nodes, 59 (50%) had macrometastasis, 43 (36.4%) had micrometastasis and 16 (13.6%) had isolated tumor cells. After a median follow-up of 53 months, the locoregional recurrence rate was 2.5% without any axillary recurrence, and systemic recurrence rate was 11.9%. Factors associated with worse disease-free survival were having a cT2-3 stage and a triple-negative subtype disease. Having triple-negative tumor was the only significant factor associated with worse disease-specific survival.
Patients with cN0 HER2-positive and triple-negative breast cancer with low-volume axillary metastases treated with upfront SLNB-alone showed excellent local control with nodal irradiation.
包括美国外科医师学会肿瘤学组（ACOSOG）Z0011试验和SENOMAC试验在内的随机试验大多纳入了激素受体阳性乳腺癌患者，而具有侵袭性肿瘤生物学行为的患者数量有限。因此，我们评估了在初次手术时对前哨淋巴结（SLN）阳性的HER2阳性或三阴性乳腺癌患者省略腋窝淋巴结清扫术的肿瘤学安全性。
这项回顾性队列研究纳入了临床淋巴结阴性的HER2阳性和三阴性乳腺癌患者，这些患者仅接受了前哨淋巴结活检（SLNB）且病理淋巴结阳性（pN+）。几乎所有患者（97.5%）都接受了淋巴结放疗。
2015年至2020年期间，来自8个中心的118例HER2阳性（n = 79，67%）和三阴性（n = 39，33%）肿瘤患者被纳入研究。其中，94.9%为cT1-2期，72%接受了保乳手术。大多数患者（n = 98，83.1%）有1个转移性前哨淋巴结。在前哨淋巴结受累的患者中，59例（50%）有大转移灶，43例（36.4%）有微转移灶，16例（13.6%）有孤立肿瘤细胞。中位随访53个月后，局部区域复发率为2.5%，无腋窝复发，全身复发率为11.9%。与无病生存期较差相关的因素为cT2-3期和三阴性亚型疾病。三阴性肿瘤是与疾病特异性生存期较差相关的唯一显著因素。
对于cN0、HER2阳性和三阴性乳腺癌且腋窝转移灶较小的患者，仅行初次SLNB并接受淋巴结放疗可实现良好的局部控制。
