Sabah Jonathan, Marouk Alexis, Molière Sébastien, Lodi Massimo
Breast Reconstructive and Plastic Surgery, Louis Pasteur Hospital, 68000 Colmar, France.
Assistance Publique-Hôpitaux de Paris (APHP), 75610 Paris, France.
J Clin Med. 2025 Sep 6;14(17):6314. doi: 10.3390/jcm14176314.
Axillary lymph node biopsy (ALND) has traditionally been considered the gold standard for axillary staging and treatment in clinically node-positive breast cancer patients. However, in patients with nodal disease, the therapeutic benefit of ALND is uncertain. This study, based on a large cohort, aims to evaluate breast cancer-specific survival depending on the extent of axillary surgery in non-metastatic breast cancer using real-world data from the Surveillance, Epidemiology, and End Results (SEER) database. This retrospective cohort study comprised 825,240 patients diagnosed with breast cancer between 2000 and 2020. ALND was associated with a worse survival outcome in pN0 and pN1 populations (respectively, hazard ratio [HR] 1.16; 95% confidence interval [CI] 1.12-1.2; < 0.001 and HR 1.38; 95%CI 1.3-1.46; < 0.001). In pN2 and pN3 populations, there was ~4.3% relative reduction in the hazard of breast cancer-related death for each additional node removed; and higher positive-to-removed lymph node ratio was associated with worse prognosis (HR 3.450; 95%CI 2.99-3.98; < 0.001). SLNB is associated with significantly better specific survival compared to ALND in negative/low axillary involvement, in higher axillary involvement categories extensive axillary surgery was associated with better prognosis.
传统上，腋窝淋巴结活检（ALND）一直被视为临床淋巴结阳性乳腺癌患者腋窝分期和治疗的金标准。然而，对于有淋巴结疾病的患者，ALND的治疗益处尚不确定。本研究基于一个大型队列，旨在利用监测、流行病学和最终结果（SEER）数据库中的真实世界数据，评估非转移性乳腺癌患者腋窝手术范围对乳腺癌特异性生存的影响。这项回顾性队列研究纳入了2000年至2020年间确诊为乳腺癌的825240例患者。在pN0和pN1人群中，ALND与较差的生存结果相关（风险比[HR]分别为1.16；95%置信区间[CI]为1.12 - 1.2；P < 0.001和HR 1.38；95%CI为1.3 - 1.46；P < 0.001）。在pN2和pN3人群中，每多切除一个淋巴结，乳腺癌相关死亡风险相对降低约4.3%；且阳性淋巴结与切除淋巴结的比例越高，预后越差（HR 3.450；95%CI为2.99 - 3.98；P < 0.001）。在腋窝转移阴性/低转移的情况下，与ALND相比，前哨淋巴结活检（SLNB）与显著更好的特异性生存相关，在腋窝转移较高的类别中，广泛腋窝手术与较好的预后相关。
