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根据目前的TNM分期系统，乳腺癌对侧腋窝淋巴结转移属于M1和IV期病变。由于对侧腋窝淋巴结转移的意义及其治疗方法（究竟根治切除治疗还是单纯姑息治疗）研究数据缺乏，故其处理原则仍不确定，无疑给临床带来巨大挑战。 2020年5月21日，美国肿瘤外科学会和美国乳腺外科医师学会官方期刊《肿瘤外科学报》在线发表欧洲肿瘤研究院、意大利米兰大学、米兰比科卡大学的研究报告，调查了乳腺癌对侧腋窝淋巴结转移患者的治疗方法和生存结局。 该单中心回顾研究对1997年以来意大利米兰欧洲肿瘤研究院病理证实对侧腋窝淋巴结转移的47例尚未发生远处转移患者进行回顾分析。可行治疗方法包括手术、放疗和全身治疗。主要结局为无病生存和总体生存。 结果发现，原发肿瘤确诊后发生对侧腋窝淋巴结转移的中位时间为73个月（范围5～500个月）。其中，保乳手术25例、乳房切除22例，放疗33例，腋窝清扫46例、前哨淋巴结活检1例，化疗23例、化疗＋内分泌治疗9例、内分泌治疗14例。 经过中位随访5.4年（四分位距：2.9～7.0年）
因此，该研究结果表明，如果对侧腋窝淋巴结转移接受以根治为目的的手术和全身治疗，与其他部位远处转移相比，患者生存结局相对较好，尤其总体生存。 对此，作者提出一种新的临床方案：TNM分期系统不应将对侧腋窝淋巴结转移归入M1和IV期，而是应该归入N3期病变。 Ann Surg Oncol. 2020 May 21. [Epub ahead of print] Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M. European Institute of Oncology, IRCCS, Milan, Italy; University of Milan, Milan, Italy; University of Milan-Bicocca, Milan, Italy. BACKGROUND: Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge. PATIENTS AND METHODS: Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS). RESULTS: Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59). CONCLUSION: These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease. PMID: 32436193 DOI: 10.1245/s10434-020-08605-4
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