背景:研究支持前哨淋巴结阳性患者省略腋窝淋巴结清扫术(ALND),对于存在临床阳性淋巴结的患者,建议使用ALND。这里,我们评估接受ALND的雌激素受体阳性(ER+)乳腺癌患者的患者和肿瘤特征以及病理淋巴结分期,以确定是否存在基于淋巴结表现的差异.
方法:2010年至2019年的回顾性图表回顾定义了三组ER+乳腺癌患者,这些患者接受了ALND的阳性淋巴结:SLN+(SLN活检发现的阳性淋巴结),cNUS(异常的术前US和活检),和cNpalp(明显的腺病)。排除接受新辅助化疗或腋窝复发的患者。
结果:在191名患者中,94个是SLN+,40个是cNUS,57人是cNpalp。与cNpalp相比,SLN+患者更年轻(56岁vs64岁,p<0.01),更常在绝经前(41%vs14%,p<0.01),和白色(65%对39%,p=0.01),低度肿瘤更多(36%vs8%,p<0.01)。PR+的比率(p=0.16),Ki67表达水平(p=0.07)和LVI水平(p=0.06)在组间没有显著差异.患有SLN+疾病的患者,与cNUS的38%(p=0.1)和cNpalp的40%(p=0.01)相比,64%患有pN1疾病。关于单变量分析,肿瘤大小(p=0.01)和组织学(p=0.04)与pN1疾病显着相关,在多变量分析中,大小仍然是独立的预测因子(p=0.02)。
结论:从历史上看,较高的风险特征归因于临床阳性淋巴结排除ALND的患者,但是当限制对ER+乳腺癌患者的评估时,只有肿瘤大小与较高的淋巴结分期相关。
BACKGROUND: Studies support omission of axillary lymph node dissection (ALND) for patients with sentinel node-positive disease, with ALND recommended for patients who present with clinically positive nodes. Here, we evaluate patient and tumor characteristics and pathologic nodal stage of patients with estrogen receptor-positive (ER +) breast cancer who undergo ALND to determine if differences exist based on nodal presentation.
METHODS: Retrospective chart review from 2010 to 2019 defined three groups of patients with ER + breast cancer who underwent ALND for positive nodes: SLN + (positive node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp (palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented with axillary recurrence were excluded.
RESULTS: Of 191 patients, 94 were SLN + , 40 were cNUS, and 57 were cNpalp. Patients with SLN + compared with cNpalp were younger (56 vs 64 years, p < 0.01), more often pre-menopausal (41% vs 14%, p < 0.01), and White (65% vs 39%, p = 0.01) with more tumors that were low-grade (36% vs 8%, p < 0.01). Rates of PR + (p = 0.16), levels of Ki67 expression (p = 0.07) and LVI (p = 0.06) did not differ significantly among groups. Of patients with SLN + disease, 64% had pN1 disease compared to 38% of cNUS (p = 0.1) and 40% of cNpalp (p = 0.01). On univariable analysis, tumor size (p = 0.01) and histology (p = 0.04) were significantly associated with pN1 disease, with size remaining an independent predictor on multivariable analysis (p = 0.02).
CONCLUSIONS: Historically, higher risk features have been attributed to patients with clinically positive nodes precluding omission of ALND, but when restricting evaluation to patients with ER + breast cancer, only tumor size is associated with higher nodal stage.