Background: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. Methods: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical–pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. Results: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n= 13, 29.5%), locally advanced carcinoma (n= 5, 11.4%), occult carcinoma (n= 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n= 8, 18.2%). Conclusions: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.
背景：在当前靶向腋窝清扫（TAD）时代，仍存在需行腋窝淋巴结清扫术（ALND）但术后病理检查证实淋巴结转移已消退（ypN0）的病例。在此情况下，ALND可能意味着不必要的过度治疗。方法：基于前瞻性维护的数据库，在综合癌症中心开展了一项回顾性研究。研究选取2020年至2023年间接受新辅助化疗（NAC）后手术的患者，特别是NAC后直接具备ALND指征的病例。随后，比较了ypN0病例与持续转移（ypN+）病例的临床病理特征，并从医疗记录中提取了ypN0病例实施ALND的具体原因。结果：在117例患者的118个病例中具备ALND指征，其中44例（37%）观察到ypN0状态。炎性乳腺癌（68%）、非腔面型HER2阳性表型（76%）、原发灶发生组织病理学消退的癌灶（76%）或仅存非浸润成分的ypTis癌灶（67%）中，ypN0病例比例显著更高。ypN0病例实施ALND的典型原因包括：炎性乳腺癌（13例，29.5%）、局部晚期乳腺癌（5例，11.4%）、隐匿性乳腺癌（2例，4.5%），或NAC后超声检查仍显示持续性淋巴结肿大——尤其在HER2阳性和三阴性乳腺癌（TNBC）表型中（8例，18.2%）。结论：通过真实世界证据数据分析，本研究识别出接受NAC治疗的乳腺癌患者中可能存在腋窝手术过度治疗的亚群，包括炎性乳腺癌、局部晚期乳腺癌、隐匿性乳腺癌患者，以及NAC后超声检查仍显示持续性淋巴结肿大的患者——特别是在HER2阳性和TNBC肿瘤表型中。
肿瘤(癌症)患者之家