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早期乳腺癌术前新辅助化疗后，少量残余淋巴结病变的预后意义尚不明确。 2019年6月21日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表哈佛大学医学院布莱根妇女医院、达纳法伯癌症研究院、达纳法伯布莱根妇女癌症中心（以下简称波士顿癌症中心）的研究报告，探讨了乳腺癌术前新辅助化疗后残余腋窝淋巴结微转移或孤立肿瘤细胞的预后意义。 该研究根据波士顿癌症中心、全国癌症数据库，分别确定I～III期乳腺癌术前新辅助化疗患者967例、35536例。通过生存曲线法，推算不同病理淋巴结分期的无病生存和总生存。通过多因素比例风险回归模型校正分析，评定临床因素对生存结局的影响。 结果，波士顿癌症中心患者术前新辅助化疗后残余孤立肿瘤细胞27例（2.8%）、微转移61例（6.3%）。术前新辅助化疗后残余孤立肿瘤细胞、微转移与病理淋巴结阴性患者相比：
全国癌症数据库患者术前新辅助化疗后孤立肿瘤细胞543例（1.5%）、微转移1132例（3.2%）。术前新辅助化疗后残余孤立肿瘤细胞、微转移与病理淋巴结阴性患者相比：
根据亚组分析，少量残余淋巴结病变对三阴性和HER2阳性乳腺癌患者死亡的影响最为显著。 因此，该研究结果表明，早期乳腺癌术前新辅助化疗后，少量残余淋巴结病变与淋巴结阴性相比，患者的无病生存和总生存显著较差。 Ann Surg Oncol. 2019 Jun 21. [Epub ahead of print] Prognostic Significance of Residual Axillary Nodal Micrometastases and Isolated Tumor Cells After Neoadjuvant Chemotherapy for Breast Cancer. Wong SM, Almana N, Choi J, Hu J, Gagnon H, Natsuhara K, Shen AH, DeSantis S, Dominici L, Golshan M, Weiss A, Bellon J, Mittendorf EA, King TA. Brigham and Women's Hospital, Boston, USA; Dana-Farber/Brigham and Women's Cancer Center, Boston, USA; Dana-Farber Cancer Institute, Boston, USA. BACKGROUND: The prognostic significance of low-volume residual nodal disease following neoadjuvant chemotherapy (NAC) is unknown. METHODS: Women with cT1-4N0-1 breast cancer treated with NAC were identified from Dana-Farber/Brigham and Women's Cancer Center (DFBWCC) and the National Cancer Database (NCDB). Disease-free survival (DFS) and overall survival (OS) estimates according to pathologic nodal status were calculated using the Kaplan-Meier method, with Cox proportional hazards regression used to assess the effect of clinical variables on survival outcomes. RESULTS: Among 967 DFBWCC patients, 27 (2.8%) had residual isolated tumor cells (ITCs) and 61 (6.3%) had micrometastases. Five-year DFS was significantly worse in those with residual ITCs (73.5%) and micrometastases (74.7%) relative to those who were ypN0 following NAC (88.4%, p<0.001). On adjusted analysis, those with residual ITCs (hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.20-3.81) and micrometastases (HR 2.14, 95% CI 1.20-3.81) had increased risk of recurrence relative to ypN0 patients. Among 35,536 NCDB patients, 543 (1.5%) had ITCs and 1132 (3.2%) had micrometastases. Five-year OS estimates were significantly worse with increasing residual nodal burden: ypN0, 88.9%; ypN0[i+], 82.8%; ypN1mi, 79.5%; ypN1, 77.6% (p<0.001). Compared with patients with ypN0 disease, NCDB patients with ITCs and micrometastases had 1.9- and 2.2-fold risk of death (p<0.001). On subgroup analysis, the effect of low-volume residual disease on mortality was most pronounced in patients with triple-negative and human epidermal growth factor receptor 2 (HER2)-positive disease. CONCLUSIONS: Low-volume residual nodal disease following NAC is associated with poorer DFS and OS relative to those who are node negative. PMID: 31228134 DOI: 10.1245/s10434-019-07517-2
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