Background: The management of the axilla in breast cancer patients with isolated chest wall recurrence (CWR) after mastectomy remains controversial. Although sentinel lymph node biopsy (SLNB) for restaging is feasible, its role is unclear. We aimed to determine if the omission of axillary restaging surgery in female patients with operable presumably isolated CWRs could result in an increased risk of second recurrences. Methods: In this retrospective multicentre study, patients who developed CWRs were reviewed. We excluded patients with suspected or concomitant regional/distant metastases, bilateral cancers and patients without CWR surgery. Patients’ demographics, pathological data and subsequent recurrences were collected from a prospective database and were compared between patients with axillary lymph node dissection (ALND) and/or SLNB versus no axillary operation at CWR. Findings: A total of 194 patients with CWRs were eligible. The median age at CWR was 56.0 (IQR 47.0–67.0) years old. At recurrence, 8 (4.1%), 5 (2.6%) and 181 (93.3%) patients had ALND, SLNB and no axillary operation, respectively. Patients with no axillary surgery during CWR were associated with, at primary cancer, a lower incidence of ductal carcinoma in situ as diagnosis (p= 0.007) and older age (p= 0.022). Subsequent ipsilateral axillary (p= 0.768) and second recurrences (p= 0.061) were not statistically different between patients with and without axillary surgery at CWR on median follow-up of 59.5 (IQR 27.3–105) months. Interpretation: In patients without evidence of concomitant regional or distant metastasis at CWR diagnosis, omission of axillary restaging surgery was not associated with an increased ipsilateral axillary or second recurrences on long-term follow-up.
背景：对于乳房切除术后出现孤立性胸壁复发（CWR）的乳腺癌患者，腋窝处理策略仍存争议。虽然前哨淋巴结活检（SLNB）用于再分期具有可行性，但其临床价值尚不明确。本研究旨在探讨对可手术的疑似孤立性CWR女性患者省略腋窝再分期手术是否会增加二次复发风险。 方法：本回顾性多中心研究纳入发生CWR的患者。排除标准包括疑似或合并区域/远处转移、双侧乳腺癌及未接受CWR手术的患者。从前瞻性数据库中收集患者人口统计学特征、病理学资料及后续复发情况，比较CWR时接受腋窝淋巴结清扫术（ALND）和/或SLNB与未行腋窝手术患者的差异。 结果：共194例CWR患者符合入组标准。CWR确诊中位年龄为56.0岁（IQR 47.0-67.0）。复发时，分别有8例（4.1%）、5例（2.6%）和181例（93.3%）患者接受ALND、SLNB及未行腋窝手术。CWR时未行腋窝手术的患者在原发癌阶段具有以下特征：导管原位癌诊断率较低（p=0.007）且年龄较大（p=0.022）。在中位59.5个月（IQR 27.3-105）的随访期间，CWR时是否接受腋窝手术患者的同侧腋窝复发率（p=0.768）与二次复发率（p=0.061）均无统计学差异。 结论：对于CWR诊断时无区域或远处转移证据的患者，长期随访显示省略腋窝再分期手术并未增加同侧腋窝复发或二次复发风险。
肿瘤(癌症)患者之家