Kim Ee Jin, Yoo Tae Kyung, Kim Jisun, Chung Il Yong, Ko Beom Seok, Kim Hee Jeong, Lee Jong Won, Son Byung Ho, Lee Sae Byul
Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Sci Rep. 2025 Apr 1;15(1):11128. doi: 10.1038/s41598-024-84841-y.
Axillary lymph node dissection (ALND) omission improves quality of life but is only considered under certain conditions. We investigated expanding these conditions in patients receiving neoadjuvant chemotherapy (NAC) for clinical N2-3, pathological N0 breast cancer. We retrospectively reviewed data of 1346 patients with clinical N2-3, M0, who underwent surgical resection (sentinel lymph node biopsy [SLNB] only, or level I-II ALND with/without SLNB) following NAC from January 2008 to December 2021. Univariate and multivariate analyses of overall (OS), disease-free (DFS), regional recurrence-free (RFS), and axillary recurrence-free survival (ARFS) were performed before and after propensity score matching (PSM) to control for confounding factors. Of the total patients, 521 (37.5%) achieved an axillary pathological complete response (ypN0). Of these, 293 (56.2%) underwent SLNB only. The median OS was 52.7 months. After PSM, SLNB-only and ALND groups showed no significant differences in ARFS (long-rank p = 0.765), RFS (long-rank p = 0.764), DFS (long-rank p = 0.186), and OS (long-rank p = 0.760). The 5-year ARFS (97.3 vs. 96.7%) and OS (97.7 vs. 97.3%) of both groups did not differ significantly. ALND omission after NAC in clinical N2-3, pathological N0 patients was not inferior to ALND,. Clinical N2-3 patients achieving ypN0 following NAC may be safely treated with SLNB alone.
省略腋窝淋巴结清扫术（ALND）可改善生活质量，但仅在特定条件下才会考虑。我们研究了在接受新辅助化疗（NAC）的临床N2-3、病理N0乳腺癌患者中扩大这些条件的情况。我们回顾性分析了2008年1月至2021年12月期间1346例临床N2-3、M0且在接受NAC后接受手术切除（仅前哨淋巴结活检[SLNB]，或行或不行SLNB的Ⅰ-Ⅱ级ALND）的患者的数据。在倾向评分匹配（PSM）前后进行单因素和多因素分析，以控制混杂因素，分析总生存期（OS）、无病生存期（DFS）、区域无复发生存期（RFS）和腋窝无复发生存期（ARFS）。在全部患者中，521例（37.5%）实现了腋窝病理完全缓解（ypN0）。其中，293例（56.2%）仅接受了SLNB。中位OS为52.7个月。PSM后，仅SLNB组和ALND组在ARFS（长秩检验p = 0.765）、RFS（长秩检验p = 0.764）、DFS（长秩检验p = 0.186）和OS（长秩检验p = 0.760）方面无显著差异。两组的5年ARFS（97.3%对96.7%）和OS（97.7%对97.3%）无显著差异。临床N2-3、病理N0患者在NAC后省略ALND并不逊于ALND。临床N2-3患者在NAC后实现ypN0可单独行SLNB安全治疗。
