[临床淋巴结阴性乳腺癌是否需要进一步行腋窝清扫？]

[Is axillary dissection in clinically lymph node-negative breast carcinoma further indicated?].

作者信息

Böhler F K, Eiter H, Rhomberg W

机构信息

Abteilung für Strahlentherapie, Landeskrankenhaus Feldkirch.

出版信息

Strahlenther Onkol. 1998 Dec;174(12):605-12. doi: 10.1007/BF03038507.

DOI:10.1007/BF03038507

PMID:9879346

Abstract

BACKGROUND

In the treatment of breast cancer, the indication for adjuvant systemic treatment was extended also to nodal negative tumor stages in the last years. For that reason, the indicator status of axillary dissection lost some of its importance. Therefore, in node negative patients, the necessity of axillary dissection and the use of definitive axillary radiotherapy, which causes less morbidity, may be reconsidered.

METHODS

In a review of the related literature, we present international treatment experiences related to axillary dissection, axillary radiotherapy and "sentinel node dissection" (SLND). In addition, our long-term experiences in 19 patients with clinically negative axillary nodes treated by conservative surgery without axillary dissection but axillary radiotherapy, are reported.

RESULTS

The median rate of axillary recurrences with axillary radiotherapy is 2.0%, the regional (supraclavicular and retrosternal) recurrence rate 2.7%. With axillary dissection, axillary recurrences occur in 1 to 2%, in nodal negative stages in 0 to 1%, the median regional recurrence rate is 2.2%. A meta-analysis presented in 1995 by the Early Breast Cancer Study Group showed no significant difference in the regional recurrence rate or the overall survival between axillary dissection and axillary radiotherapy. With SLND, usually only one axillary node is excised. With the help of molecular and immunohistochemical methods, SLND may predict axillary involvement with high precision.

CONCLUSIONS

Definitive radiotherapy of the axilla is a valid treatment option for patients without palpable axillary nodes with the potential advantage of being less cost intensive and better tolerated. If the indication for systemic therapy is no more dependent on the axillary status, axillary dissection may be replaced by axillary radiotherapy. In small tumors without risk factors and without indication for systemic therapy, SLND seems to be the best treatment option.

摘要

背景

在乳腺癌治疗中，近年来辅助性全身治疗的适应证已扩展至腋窝淋巴结阴性的肿瘤分期。因此，腋窝清扫的指征地位有所下降。所以，对于腋窝淋巴结阴性的患者，腋窝清扫的必要性以及采用导致较低发病率的确定性腋窝放疗的应用，可能需要重新考虑。

方法

在回顾相关文献时，我们呈现了与腋窝清扫、腋窝放疗及“前哨淋巴结活检”（SLND）相关的国际治疗经验。此外，还报告了我们对19例临床腋窝淋巴结阴性患者采用保乳手术（未进行腋窝清扫但接受腋窝放疗）的长期经验。

结果

腋窝放疗后的腋窝复发率中位数为2.0%，区域（锁骨上和胸骨后）复发率为2.7%。腋窝清扫后，腋窝复发率为1%至2%，腋窝淋巴结阴性分期的复发率为0%至1%，区域复发率中位数为2.2%。早期乳腺癌研究组在1995年进行的一项荟萃分析显示，腋窝清扫与腋窝放疗在区域复发率或总生存率方面无显著差异。采用SLND时，通常仅切除一个腋窝淋巴结。借助分子和免疫组化方法，SLND可高精度预测腋窝受累情况。