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Abstract：
BACKGROUND: The significance of minimal residual axillary disease, specifically micrometastases, following neoadjuvant systemic therapy (NST) remains largely unexplored. Our study aimed to elucidate the prognostic implications of micrometastases in axillary and sentinel lymph nodes following NST.
METHODS: This retrospective study analyzed primary breast cancer patients who underwent surgery after NST from September 2006 through February 2018. All patients received axillary lymph node dissection (ALND), either with or without sentinel lymph node biopsy. Recurrence-free survival (RFS)-associated variables were identified using a multivariate Cox proportional hazard model.
RESULTS: Of the 978 patients examined, 438 (44.8%) exhibited no pathologic lymph node involvement (ypN0) after NST, while 89 (9.1%) had micrometastases (ypN1mi) and 451 (46.7%) had macrometastases (ypN+). Notably, 51.1% of the patients with sentinel lymph node micrometastases (SLNmi) had additional metastases, nearly triple that of SLN-negative patients (P < 0.001), and 29.8% of SLNmi patients were upstaged with the ALND. Although ypN1mi was not associated with RFS in patients post-NST (HR, 1.02; 95% CI, 0.42-2.49; P = 0.958), SLNmi patients experienced significantly worse RFS compared to SLN-negative patients (hazard ratio [HR], 2.23; 95% confidence intervals [CI], 1.12-4.46; P = 0.023). Additional metastases in SLNmi were more prevalent in patients with larger residual breast disease greater than 20 mm, HR-positive/HER2-negative subtype, and low Ki-67 LI (< 14%).
CONCLUSIONS: SLNmi is a negative prognostic factor significantly associated with additional non-SLN metastases, while ypN1mi does not influence the prognosis compared to ypN0. Hence, additional ALND may be warranted to confirm axillary nodal status in patients with SLNmi.
METHODS: This retrospective study analyzed primary breast cancer patients who underwent surgery after NST from September 2006 through February 2018. All patients received axillary lymph node dissection (ALND), either with or without sentinel lymph node biopsy. Recurrence-free survival (RFS)-associated variables were identified using a multivariate Cox proportional hazard model.
RESULTS: Of the 978 patients examined, 438 (44.8%) exhibited no pathologic lymph node involvement (ypN0) after NST, while 89 (9.1%) had micrometastases (ypN1mi) and 451 (46.7%) had macrometastases (ypN+). Notably, 51.1% of the patients with sentinel lymph node micrometastases (SLNmi) had additional metastases, nearly triple that of SLN-negative patients (P < 0.001), and 29.8% of SLNmi patients were upstaged with the ALND. Although ypN1mi was not associated with RFS in patients post-NST (HR, 1.02; 95% CI, 0.42-2.49; P = 0.958), SLNmi patients experienced significantly worse RFS compared to SLN-negative patients (hazard ratio [HR], 2.23; 95% confidence intervals [CI], 1.12-4.46; P = 0.023). Additional metastases in SLNmi were more prevalent in patients with larger residual breast disease greater than 20 mm, HR-positive/HER2-negative subtype, and low Ki-67 LI (< 14%).
CONCLUSIONS: SLNmi is a negative prognostic factor significantly associated with additional non-SLN metastases, while ypN1mi does not influence the prognosis compared to ypN0. Hence, additional ALND may be warranted to confirm axillary nodal status in patients with SLNmi.
摘要：
背景：微小残留腋窝病的意义，特别是微转移，新辅助系统治疗(NST)后仍未被探索.我们的研究旨在阐明NST后腋窝和前哨淋巴结微转移的预后意义。
方法：这项回顾性研究分析了2006年9月至2018年2月在NST后接受手术的原发性乳腺癌患者。所有患者均接受腋窝淋巴结清扫术(ALND),有或没有前哨淋巴结活检。使用多变量Cox比例风险模型鉴定无复发生存(RFS)相关变量。
结果：在检查的978名患者中，438（44.8％）在NST后未表现出病理淋巴结受累（ypN0），89（9.1％）有微转移（ypN1mi），451（46.7％）有宏观转移（ypN）。值得注意的是,51.1%的前哨淋巴结微转移(SLNmi)患者有额外的转移,SLN阴性患者的近三倍(P<0.001)，和29.8%的SLNmi患者被ALND升级。尽管ypN1mi与NST后患者的RFS无关(HR，1.02；95%CI，0.42-2.49；P=0.958），与SLN阴性患者相比，SLNmi患者的RFS明显更差（风险比[HR]，2.23；95%置信区间[CI]，1.12-4.46；P=0.023）。SLNmi中的其他转移在较大的残留乳腺疾病大于20mm的患者中更为普遍，HR阳性/HER2阴性亚型，和低Ki-67LI（<14%）。
结论：SLNmi是与其他非SLN转移显著相关的负面预后因素，而ypN1mi与ypN0相比不影响预后。因此，可能需要额外的ALND来确认SLNmi患者的腋窝淋巴结状态.
方法：这项回顾性研究分析了2006年9月至2018年2月在NST后接受手术的原发性乳腺癌患者。所有患者均接受腋窝淋巴结清扫术(ALND),有或没有前哨淋巴结活检。使用多变量Cox比例风险模型鉴定无复发生存(RFS)相关变量。
结果：在检查的978名患者中，438（44.8％）在NST后未表现出病理淋巴结受累（ypN0），89（9.1％）有微转移（ypN1mi），451（46.7％）有宏观转移（ypN）。值得注意的是,51.1%的前哨淋巴结微转移(SLNmi)患者有额外的转移,SLN阴性患者的近三倍(P<0.001)，和29.8%的SLNmi患者被ALND升级。尽管ypN1mi与NST后患者的RFS无关(HR，1.02；95%CI，0.42-2.49；P=0.958），与SLN阴性患者相比，SLNmi患者的RFS明显更差（风险比[HR]，2.23；95%置信区间[CI]，1.12-4.46；P=0.023）。SLNmi中的其他转移在较大的残留乳腺疾病大于20mm的患者中更为普遍，HR阳性/HER2阴性亚型，和低Ki-67LI（<14%）。
结论：SLNmi是与其他非SLN转移显著相关的负面预后因素，而ypN1mi与ypN0相比不影响预后。因此，可能需要额外的ALND来确认SLNmi患者的腋窝淋巴结状态.
