Lu Yongjin, Shi Zhiqiang, Zhao Qiuchen, Bi Zhao, Sun Xiao, Wang Chunjian, Jia Ruijie, Zheng Junsheng, Sun Jing, Wang Yongsheng, Qiu Pengfei
Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, China.
Cancer Research UK Cambridge Centre and Department of Oncology, University of Cambridge, Cambridge, CB2 0XZ, UK.
BMC Cancer. 2025 May 13;25(1):866. doi: 10.1186/s12885-025-14215-8.
The practice of omitting of axillary lymph node dissection (ALND) in patients with a low tumor burden in sentinel lymph nodes (SLN) has become standard in managing early-stage breast cancer. This study aims to determine the clinical application value of regional lymph node irradiation (RNI) in such patients by analyzing relevant clinical and pathological data and survival outcomes.
We gathered data on 7603 patients from Shandong Cancer Hospital and Institutet between September 2014 and December 2022. Patients identified as SLN-positive who omitted ALND were classified based on whether RNI was included in their radiotherapy target area. Their case data and treatment details were analyzed, followed by regular follow-up assessments. The Kaplan-Meier method was used to compare recurrence and survival differences between the two groups. The primary outcome measured was locoregional recurrence-free survival (LRRFS), and the secondary outcomes were invasive disease-free survival (iDFS) and overall survival (OS).
Out of 326 women, they were divided into the RNI group (n = 154) and no-RNI groups (n = 172). After a median follow-up of 47 months, the recurrence rate in the no-RNI group was 4.7%. Multivariate Cox proportional hazards analysis identified the triple-negative breast cancer (TNBC) subtype as a strong independent prognostic factor for iDFS (P < 0.001). Although RNI did not reach statistical significance in univariate analysis, it exhibited a significant protective effect after multivariate adjustment (P = 0.024). Kaplan-Meier survival analysis further revealed that RNI significantly improved LRRFS and iDFS (P = 0.042; P = 0.037, respectively), whereas no OS benefit was observed.
As the practice of surgical de-escalation becomes more widely adopted, the precise application of radiotherapy for SLN-positive patients exempt from ALND has become a key area of research. This study supports the use of RNI as crucial adjunctive treatment to enhance locoregional control, particularly for high-risk subgroups.
在前哨淋巴结（SLN）肿瘤负荷较低的患者中省略腋窝淋巴结清扫术（ALND）的做法已成为早期乳腺癌管理的标准。本研究旨在通过分析相关临床和病理数据以及生存结果，确定区域淋巴结照射（RNI）在此类患者中的临床应用价值。
我们收集了2014年9月至2022年12月期间山东肿瘤医院和研究所7603例患者的数据。被确定为SLN阳性且省略ALND的患者根据其放疗靶区是否包括RNI进行分类。分析他们的病例数据和治疗细节，随后进行定期随访评估。采用Kaplan-Meier方法比较两组之间的复发和生存差异。主要观察指标为局部区域无复发生存期（LRRFS），次要观察指标为无浸润性疾病生存期（iDFS）和总生存期（OS）。
在326名女性中，她们被分为RNI组（n = 154）和非RNI组（n = 172）。中位随访47个月后，非RNI组的复发率为4.7%。多变量Cox比例风险分析确定三阴性乳腺癌（TNBC）亚型是iDFS的一个强有力的独立预后因素（P < 0.001）。尽管RNI在单变量分析中未达到统计学意义，但在多变量调整后显示出显著的保护作用（P = 0.024）。Kaplan-Meier生存分析进一步表明，RNI显著改善了LRRFS和iDFS（分别为P = 0.042；P = 0.037），而未观察到对OS有获益。
随着手术降阶梯做法的更广泛采用，对于免除ALND的SLN阳性患者，精确应用放疗已成为一个关键研究领域。本研究支持将RNI用作关键的辅助治疗以加强局部区域控制，特别是对于高危亚组。
