PDF(Pubmed)
Abstract：
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：
由于潜在的治疗不足，在接受前哨淋巴结（SN）分离的肿瘤细胞（ITC）或微转移的乳房切除术的患者中，腋窝淋巴结清扫（cALND）的完成存在争议，在7％至18％的患者中检测到非前哨淋巴结（NSN）受累。这项研究评估了cALND遗漏对接受SNITC或微转移乳房切除术治疗的乳腺癌（BC）患者队列的生存影响。在554例早期BC患者中（391pN1mi，163ITC)，NSN参与率为13.2%(49/371)。中位随访时间为66.46个月，多变量分析显示，cALND遗漏与总生存期(OS，HR：2.583，p=0.043），无病生存率(DFS，HR：2.538，p=0.008），和无转移生存率(MFS，HR:2.756,p=0.014)。对于Her2阳性或三阴性患者，cALND遗漏显著影响DFS(HR:38.451,p=0.030)。在ER阳性Her2阴性BC中，DFS,操作系统,无复发生存率（RFS），和MFS与cALND遗漏显着相关（DFSHR：2.358，p=0.043；OSHR：3.317；RFSHR：2.538；MFSHR：2.756）。对于161名年龄≤50岁的ER阳性/Her2阴性癌症患者，OS和乳腺癌特异性生存率（BCSS）明显受到cALND遗漏的影响（OSHR：103.47，p=0.004；BCSSHR：50.874，p=0.035）。这些发现表明cALND遗漏对SN微转移或ITC患者的潜在负面预后影响。需要进一步的随机试验。
