|
对于临床淋巴结阴性乳腺癌患者，前哨淋巴结活检与术前新辅助化疗的最佳顺序、术前新辅助化疗后避免腋窝淋巴结清扫的决定因素尚不明确。 2019年7月23日，全国乳腺中心联盟（原美国乳腺疾病学会）《乳腺杂志》在线发表山东大学附属肿瘤医院王永胜等学者的研究报告，探讨了临床淋巴结阴性乳腺癌患者前哨淋巴结活检与术前新辅助化疗的最佳顺序，并且分析了术前新辅助化疗后有选择地避免腋窝淋巴结清扫的可行性。 该单中心回顾研究对2010年4月～2018年8月山东大学附属肿瘤医院845例乳腺癌新辅助化疗患者进行回顾，对其中临床淋巴结阴性患者不同临床病理特征与新辅助化疗后腋窝淋巴结阴性之间的相关性进行分析。 结果发现，临床淋巴结阴性患者148例，其中：
新辅助化疗后腋窝淋巴结阴性患者123例，其中：
根据单因素分析，完成3～4个周期新辅助化疗后腋窝淋巴结阴性的显著相关因素：
根据多因素分析，完成3～4个周期新辅助化疗后腋窝淋巴结阴性的独立预测因素：
根据单因素分析，完成6～8个周期新辅助化疗后腋窝淋巴结阴性的显著相关因素：
根据多因素分析，完成6～8个周期新辅助化疗后腋窝淋巴结阴性的独立预测因素：
因此，该研究结果表明，对于不同分子亚型的临床淋巴结阴性乳腺癌患者，为了减少腋窝淋巴结清扫的风险，前哨淋巴结活检与新辅助化疗的最佳顺序可能有所不同：对于激素受体阳性且HER2阴性患者，推荐先行前哨淋巴结活检、后行新辅助化疗；对于三阴性或激素受体阴性且HER2阳性乳腺癌患者，推荐先行新辅助化疗、后行前哨淋巴结活检。由于临床淋巴结阴性患者的新辅助化疗后腋窝淋巴结阴性率较高，腋窝淋巴结清扫手术分期可以有选择地避免，尤其对于激素受体阴性HER2阳性或三阴性乳腺癌患者。 Breast J. 2019 Jul 23. [Epub ahead of print] Neo-adjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer. Zhi-qiang Shi, Peng-fei Qiu, Yan-bing Liu, Bin-bin Cong, Tong Zhao, Peng Chen, Chun-jian Wang, Zhao-peng Zhang, Xiao Sun, Yong-sheng Wang. Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Cheeloo College of Medicine, Shandong University, Jinan, China; School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Jinan, China. This study aimed to explore the optimal time of sentinel lymph node biopsy (SLNB) and neo-adjuvant chemotherapy (NAC) and to assess the feasibility of selective elimination of axillary surgery after NAC in clinically node-negative (cN0) patients. From April 2010 to August 2018, 845 patients undergoing surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN0 patients and negative axillary lymph node after NAC (ypN0). Among the 148 cN0 patients, 83.1% (123/148) were ypN0. The rates of ypN0 in patients with hormone receptor positive (HR+)/HER2-, HR+/HER2+, HR-/HER2+, and triple-negative (TN) breast cancer were 75.4% (46/61), 82.6% (19/23), 85.2% (23/27), and 94.6% (35/37), respectively (P < 0.001). The rates of ypN0 in TN and HER2+ patients were 94.6% and 95.5%, which were significantly higher than that in HR+/HER2- patients (P < 0.05). Molecular subtypes, clinical stage, radiologic complete response, and pathologic complete response (bpCR) of the breast tumor correlated with ypN0 after full-course NAC (P < 0.05). Molecular subtypes (OR = 2.374, P = 0.033), clinical stage (OR = 0.320, P = 0.029), and bpCR (OR = 0.454, P = 0.012) were independent predictors for ypN0. The optimal time of SLNB and NAC in cN0 patients might be different among different molecular subtypes: it would be preferable to perform SLNB prior to NAC for HR+/HER2- patients, and SLNB after NAC for TN and HER2+ patients to reduce the risk of axillary lymph node dissection. In view of the high ypN0 rate in cN0 patients, axillary surgical staging might be selectively eliminated, especially for HER2+ and TN patients. KEYWORDS: axillary de-escalation management; breast cancer; clinically node-negative disease; neoadjuvant chemotherapy; sentinel lymph node biopsy DOI: 10.1111/tbj.13422 |
|
|
