Shaffer Kristina, Harris Lilian, Gentile Lori, Merrill Amelia, Kellam Lori, Fillion Michelle, Turk Peter
Department of Surgery, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Surgical Oncology, Novant Health Cancer Institute, Charlotte, NC, USA.
Breast Cancer (Auckl). 2025 Aug 10;19:11782234251352996. doi: 10.1177/11782234251352996. eCollection 2025.
While sentinel lymph node biopsy (SLNB) in breast cancer patients with limited axillary disease undergoing upfront surgery is well-accepted, there are insufficient data supporting its safety with residual nodal disease (RND) following neoadjuvant chemotherapy (NAC). To evaluate axillary management and oncologic outcomes of patients with RND. A retrospective review comparing patients receiving SLNB to those receiving axillary lymph node dissection (ALND). Patients treated for breast cancer at our institution between 2015 and 2023, who received NAC and had RND, were identified. Patient and tumor characteristics, treatments, and outcomes information were collected. The relationship between axillary management and oncologic outcomes was examined. Of 155 patients, median age was 55 years (interquartile range [IQR] 46-64) and follow-up 56 months (IQR 34-73). Most patients were pathologic tumor stage 1-2 (105, 67.7%) and nodal stage 1 (106, 68.4%), with ductal histology (127, 81.9%). The most common receptor pattern was estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative. A total of 107 (69.0%) underwent mastectomy, 47 (30.3%) lumpectomy, and 138 (89.0%) received adjuvant radiation. Regarding axillary management, 121 (78.1%) underwent ALND and 34 (21.9%) SLNB. Univariate analysis found no differences in overall survival (68.6% vs 70.6%; = 1), any recurrence (local, axillary, or distant; 36.4% vs 35.3%; = 1), or specifically axillary recurrence (9.9% vs 8.8%; = 1), between ALND and SLNB groups, respectively. This was also demonstrated on multivariate analysis. Conversely, there was a significantly increased rate of lymphedema in the ALND, 57.9%, vs the SLNB group, 35.3% ( = 0.03). ALND was not associated with improved survival or recurrence risk compared with SLNB in patients with RND following NAC, but was found to have a higher rate of lymphedema. This study is limited due to its retrospective nature. Further data, such as from the ALLIANCE A011202 trial, will help to further clarify the optimal oncologic management for this group of patients.
对于接受 upfront 手术且腋窝疾病有限的乳腺癌患者，前哨淋巴结活检（SLNB）已被广泛接受，但关于新辅助化疗（NAC）后存在残留淋巴结疾病（RND）时其安全性的数据不足。为了评估 RND 患者的腋窝处理方式及肿瘤学结局。进行一项回顾性研究，比较接受 SLNB 与接受腋窝淋巴结清扫术（ALND）的患者。确定了 2015 年至 2023 年期间在我们机构接受 NAC 且有 RND 的乳腺癌患者。收集了患者和肿瘤特征、治疗方法及结局信息。研究了腋窝处理方式与肿瘤学结局之间的关系。155 例患者中，中位年龄为 55 岁（四分位间距[IQR]46 - 64），随访时间为 56 个月（IQR 34 - 73）。大多数患者为病理肿瘤分期 1 - 2 期（105 例，67.7%）和淋巴结分期 1 期（106 例，68.4%），组织学类型为导管癌（127 例，81.9%）。最常见的受体模式为雌激素受体阳性、孕激素受体阳性和人表皮生长因子受体 2 阴性。共有 107 例（69.0%）接受了乳房切除术，47 例（30.3%）接受了肿块切除术，138 例（89.0%）接受了辅助放疗。关于腋窝处理，121 例（78.1%）接受了 ALND，34 例（21.9%）接受了 SLNB。单因素分析发现，ALND 组和 SLNB 组在总生存率（68.6%对 70.6%；P = 1）、任何复发（局部、腋窝或远处；36.4%对 35.3%；P = 1），或具体的腋窝复发率（9.9%对 8.8%；P = 1）方面均无差异。多因素分析也证实了这一点。相反，ALND 组的淋巴水肿发生率显著高于 SLNB 组，分别为 57.9%和 35.3%（P = 0.03）。在 NAC 后有 RND 的患者中，与 SLNB 相比，ALND 并未改善生存率或复发风险，但淋巴水肿发生率更高。由于本研究为回顾性性质，存在局限性。来自 ALLIANCE A011202 试验等进一步的数据将有助于进一步阐明这组患者的最佳肿瘤学管理方法。
