Dees E C, Shulman L N, Souba W W, Smith B L
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
Ann Surg. 1997 Sep;226(3):279-86; discussion 286-7. doi: 10.1097/00000658-199709000-00007.
The authors assessed the impact of axillary dissection on adjuvant systemic therapy recommendations in patients with breast cancer.
With increasing use of systemic therapy in node-negative women and the desire to reduce treatment morbidity and cost, the need for axillary dissection in clinically node-negative patients with breast cancer has been challenged.
Two hundred eighty-two women with clinically negative axillae were analyzed using a model treatment algorithm. Systemic therapy was assigned with and without data from axillary dissection. Treatment shifts based on axillary dissection data were scored.
Twenty-seven percent of clinically node-negative women had pathologically positive nodes. Eight percent of T1a and 10% of T1b tumors had positive nodes and would have been undertreated without axillary dissection. Seven percent of premenopausal women with tumors < 1 cm and 13% with tumors > or = 1 cm had treatment changed by axillary dissection. For women 50 to 60 years of age, 10% with tumors < 1 cm, 17% with tumors 1 to 2 cm with positive prognostic features, and 4% with poor prognostic features had significant treatment shifts after axillary dissection. For clinically node-negative women older than 60 years of age not eligible for chemotherapy, only 3% of those with tumors < 1 cm and none of those with tumors > or = 1 cm had their treatment changed by findings at axillary dissection. Treatment shifts based on axillary dissection were larger if the treatment algorithm allowed for more varied or more aggressive treatment options.
Data obtained from axillary dissection will alter adjuvant systemic therapy regimen in a significant number of clinically node-negative women younger than 60 years of age and for older women eligible to receive chemotherapy.
作者评估了腋窝清扫术对乳腺癌患者辅助性全身治疗建议的影响。
随着在腋窝淋巴结阴性女性中全身治疗的使用增加，以及为降低治疗的发病率和成本，乳腺癌临床腋窝淋巴结阴性患者进行腋窝清扫术的必要性受到了挑战。
使用一种模型化治疗算法对282例临床腋窝淋巴结阴性的女性进行分析。分别在有和没有腋窝清扫术数据的情况下分配全身治疗方案。对基于腋窝清扫术数据的治疗方案调整进行评分。
27%临床腋窝淋巴结阴性的女性病理检查发现腋窝淋巴结阳性。8%的T1a期肿瘤和10%的T1b期肿瘤有阳性淋巴结，若不进行腋窝清扫术，这些患者会接受不充分的治疗。肿瘤＜1cm的绝经前女性中有7%、肿瘤≥1cm的绝经前女性中有13%因腋窝清扫术改变了治疗方案。对于年龄在50至60岁的女性，肿瘤＜1cm的患者中有10%、肿瘤1至2cm且具有阳性预后特征的患者中有17%、具有不良预后特征的患者中有4%在腋窝清扫术后治疗方案有显著改变。对于年龄大于60岁且不符合化疗条件的临床腋窝淋巴结阴性女性，肿瘤＜1cm的患者中只有3%、肿瘤≥1cm的患者中无一例因腋窝清扫术的结果而改变治疗方案。如果治疗算法允许更多样化或更积极的治疗选择，基于腋窝清扫术的治疗方案调整幅度会更大。
从腋窝清扫术中获得的数据将改变大量年龄小于60岁的临床腋窝淋巴结阴性女性以及符合化疗条件的老年女性的辅助性全身治疗方案。
