文章：

对于接受前期乳房切除术及前哨淋巴结孤立肿瘤细胞或微转移治疗的乳腺癌患者，可省略腋窝淋巴结清扫术

Omission of Completion Axillary Lymph Node Dissection for Patients with Breast Cancer Treated by Upfront Mastectomy and Sentinel Node Isolated Tumor Cells or Micrometastases

原文发布日期：26 July 2024

DOI: 10.3390/cancers16152666

类型: Article

开放获取: 是

英文摘要：

Omission of completion axillary lymph node dissection (cALND) in patients undergoing mastectomy with sentinel node (SN) isolated tumor cells (ITC) or micrometastases is debated due to potential under-treatment, with non-sentinel node (NSN) involvement detected in 7% to 18% of patients. This study evaluated the survival impact of cALND omission in a cohort of breast cancer (BC) patients treated by mastectomy with SN ITC or micrometastases. Among 554 early BC patients (391 pN1mi, 163 ITC), the NSN involvement rate was 13.2% (49/371). With a median follow-up of 66.46 months, multivariate analysis revealed significant associations between cALND omission and overall survival (OS, HR: 2.583,p= 0.043), disease-free survival (DFS, HR: 2.538,p= 0.008), and metastasis-free survival (MFS, HR: 2.756,p= 0.014). For Her2-positive or triple-negative patients, DFS was significantly affected by cALND omission (HR: 38.451,p= 0.030). In ER-positive Her2-negative BC, DFS, OS, recurrence-free survival (RFS), and MFS were significantly associated with cALND omission (DFS HR: 2.358,p= 0.043; OS HR: 3.317; RFS HR: 2.538; MFS HR: 2.756). For 161 patients aged ≤50 years with ER-positive/Her2-negative cancer, OS and breast cancer-specific survival (BCSS) were notably impacted by cALND omission (OS HR: 103.47,p= 0.004; BCSS HR: 50.874,p= 0.035). These findings suggest a potential negative prognostic impact of cALND omission in patients with SN micrometastases or ITC. Further randomized trials are needed.

摘要翻译： 

对于接受乳房切除术且前哨淋巴结（SN）存在孤立肿瘤细胞（ITC）或微转移的患者，是否应省略腋窝淋巴结清扫术（cALND）存在争议，因为可能治疗不足，非前哨淋巴结（NSN）受累率在7%至18%之间。本研究评估了在接受乳房切除术且SN存在ITC或微转移的乳腺癌（BC）患者队列中，省略cALND对生存的影响。在554例早期BC患者中（391例pN1mi，163例ITC），NSN受累率为13.2%（49/371）。中位随访时间为66.46个月，多变量分析显示，省略cALND与总生存期（OS，HR：2.583，p=0.043）、无病生存期（DFS，HR：2.538，p=0.008）和无转移生存期（MFS，HR：2.756，p=0.014）存在显著关联。对于Her2阳性或三阴性患者，省略cALND显著影响DFS（HR：38.451，p=0.030）。在ER阳性Her2阴性BC中，DFS、OS、无复发生存期（RFS）和MFS与省略cALND显著相关（DFS HR：2.358，p=0.043；OS HR：3.317；RFS HR：2.538；MFS HR：2.756）。对于161例年龄≤50岁且ER阳性/Her2阴性的患者，省略cALND显著影响OS和乳腺癌特异性生存期（BCSS）（OS HR：103.47，p=0.004；BCSS HR：50.874，p=0.035）。这些发现表明，对于SN微转移或ITC患者，省略cALND可能产生不良预后影响。需要进一步的随机试验加以验证。

原文链接：

Omission of Completion Axillary Lymph Node Dissection for Patients with Breast Cancer Treated by Upfront Mastectomy and Sentinel Node Isolated Tumor Cells or Micrometastases