Jankowski Clémentine, Houvenaeghel Gilles, Renaudeau Celine, Leveque Jean, Marchal Frederic, Benbara Amélie, Barranger Emmanuel, Rouzier Roman, Cohen Monique, Classe Jean-Marc, Ladoire Sylvain, Coutant Charles
Departement of Surgical Oncology, Georges-François Leclerc Cancer Center, 1 rue du Professeur Marion, 21000, Dijon, France.
Department of Surgery, Institut Paoli Calmettes, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
Breast Cancer Res Treat. 2025 Jul;212(1):13-21. doi: 10.1007/s10549-025-07642-5. Epub 2025 May 6.
Results of MonarchE trial have changed adjuvant therapy for estrogen-receptor-positive (ER+), HER-2-negative breast cancer. Given the importance of the extent of nodal disease in this study, surgical management of the axilla has resurfaced as a question asked at multidisciplinary boards.
Using data from a cohort of Werkoff (JCO, 2009) in which patients underwent both sentinel lymph node(SLN) biopsy and axillary node dissection (ALND), we assessed the proportion of patients in whom the absence of ALND would have led to a lack of awareness of "high-risk" status. We evaluated the contribution of the Katz nomogram (that predict pN2/N3 stage) to guide possible indications for complementary ALND.
Among the 536 patients, 88 were excluded (ER- and/or isolated cells in SLN). Of patients with 1 or 2 SLN + (n = 352), only 7.9% were pN2/N3. When the ratio (number of SLN + /total number of SLN sampled) was less than 1, only 3.9% were pN2/N3. Patients with 1 or 2 SLN + met the ACOSOG Z0011 criteria so none would benefit from an ALND, but 7.9% of patients at high risk will not receive Abemaciclib. If we use the Katz nomogram (threshold ≤ 5%), this rate decrease at 3.3% but 116 patients will have an ALND with no benefit. With a threshold ≤ 20%, 5% patients at high risk will not receive Abemaciclib but 21 patients will have an ALND with no benefit.
The indications for adjuvant Abemaciclib should not lead to surgical escalation in the management of the axilla.
MonarchE试验的结果改变了雌激素受体阳性（ER+）、HER-2阴性乳腺癌的辅助治疗。鉴于本研究中淋巴结疾病范围的重要性，腋窝的手术管理再次成为多学科讨论会上被问到的问题。
利用Werkoff队列（《临床肿瘤学杂志》，2009年）的数据，其中患者同时接受了前哨淋巴结（SLN）活检和腋窝淋巴结清扫（ALND），我们评估了未进行ALND会导致未意识到“高危”状态的患者比例。我们评估了Katz列线图（预测pN2/N3期）对指导辅助性ALND可能适应症的贡献。
在536例患者中，88例被排除（ER-和/或SLN中有孤立细胞）。在有1个或2个阳性SLN的患者（n = 352）中，只有7.9%为pN2/N3。当（阳性SLN数量/取样的SLN总数）的比例小于1时，只有3.9%为pN2/N3。有1个或2个阳性SLN的患者符合美国外科医师学会肿瘤学组Z0011标准，因此没有人会从ALND中获益，但7.9%的高危患者将不会接受阿贝西利。如果我们使用Katz列线图（阈值≤5%），这个比例降至3.3%，但116例患者将进行无获益的ALND。阈值≤20%时，5%的高危患者将不会接受阿贝西利，但21例患者将进行无获益的ALND。
辅助性阿贝西利的适应症不应导致腋窝管理中的手术升级。
