PDF(Pubmed)
Abstract：
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.
RESULTS: 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.
CONCLUSIONS: 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.
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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：乳房切除术后孤立性胸壁复发（CWR）的乳腺癌患者的腋窝管理仍存在争议。尽管前哨淋巴结活检（SLNB）进行再分期是可行的，其作用尚不清楚。我们的目的是确定在可手术的可能孤立的CWR的女性患者中省略腋窝重诊手术是否会导致第二次复发的风险增加。
方法：在这项回顾性多中心研究中，对发生CWRs的患者进行了回顾.我们排除了怀疑或伴随的区域/远处转移的患者，双侧癌症和没有CWR手术的患者。患者人口统计学，从前瞻性数据库中收集病理数据和随后的复发情况,并在CWR时行腋窝淋巴结清扫术(ALND)和/或SLNB的患者与未行腋窝手术的患者之间进行比较.
结果：总共194名CWR患者符合资格。CWR的中位年龄为56.0（IQR47.0-67.0）岁。在复发时，8（4.1%），5例（2.6％）和181例（93.3％）患者患有ALND，SLNB和无腋窝手术，分别。CWR期间没有腋窝手术的患者与，在原发性癌症中，导管原位癌的诊断发生率较低（p=0.007），年龄较大（p=0.022）。随后的同侧腋窝（p=0.768）和第二次复发（p=0.061）在CWR进行和未进行腋窝手术的患者之间没有统计学差异，中位随访时间为59.5（IQR27.3-105）个月。
结论：在CWR诊断时没有伴发区域或远处转移证据的患者中，省略腋窝重建手术与长期随访中同侧腋窝复发或第二次复发无关。
方法：在这项回顾性多中心研究中，对发生CWRs的患者进行了回顾.我们排除了怀疑或伴随的区域/远处转移的患者，双侧癌症和没有CWR手术的患者。患者人口统计学，从前瞻性数据库中收集病理数据和随后的复发情况,并在CWR时行腋窝淋巴结清扫术(ALND)和/或SLNB的患者与未行腋窝手术的患者之间进行比较.
结果：总共194名CWR患者符合资格。CWR的中位年龄为56.0（IQR47.0-67.0）岁。在复发时，8（4.1%），5例（2.6％）和181例（93.3％）患者患有ALND，SLNB和无腋窝手术，分别。CWR期间没有腋窝手术的患者与，在原发性癌症中，导管原位癌的诊断发生率较低（p=0.007），年龄较大（p=0.022）。随后的同侧腋窝（p=0.768）和第二次复发（p=0.061）在CWR进行和未进行腋窝手术的患者之间没有统计学差异，中位随访时间为59.5（IQR27.3-105）个月。
结论：在CWR诊断时没有伴发区域或远处转移证据的患者中，省略腋窝重建手术与长期随访中同侧腋窝复发或第二次复发无关。
