Patterns of Axillary Surgical Care for Breast Cancer in the Era of Sentinel Lymph Node Biopsy
Patterns of Axillary Surgical Care for Breast Cancer in the Era of Sentinel Lymph Node Biopsy
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DOI：
10.1245/s10434-008-0195-5
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发表时间：
2009-03-01
影响因子：
3.7
通讯作者：
Axelrod, Deborah
中科院分区：
文献类型：
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作者：
Rescigno, John;Zampell, Jamie C.;Axelrod, Deborah
对前哨淋巴结活检（SLNB）时代可手术乳腺癌患者腋窝手术治疗的总体模式进行了研究。居住在监测、流行病学和最终结果（SEER）癌症登记的14个地理区域的可手术乳腺癌患者1998 - 2004年，239，661例患者的腋窝手术护理模式进行了评估，SLNB的使用从11%增加到59%。不进行腋窝手术的比例从14%下降到6.6%。在病理淋巴结阴性的妇女中，腋窝淋巴结清扫术（ALND）的使用率从94%下降到36%。与SLNB失败最相关的独立因素包括诊断年份（2000年：62%; 2004年：29%），外科（乳房切除术：64%;保乳手术：36%），肿瘤大小（T3：71%; T2：56%; T1：40%），年龄（千分之一日元）70岁：50%;<70岁：45%），等级（高：42%;低：38%），城市化（非大都市区：49%;大都市区：42%），以及按四分位数计算的贫困（最高：47%;最低：35%）和白领就业（最低：56%;最高：47%）。在病理淋巴结阳性的SLNB妇女中，未能完成ALND的比例从1998年的20%上升到2004年的32%。肿瘤较小、级别较低、淋巴结转移较小、无囊外浸润、年龄<70岁、语言隔离增加、非裔美国人或西班牙裔种族、白领就业的患者不太可能接受完成ALND。护理模式表明SLNB和ALND的选择既适当又不适当。
Population-based overall patterns of surgical management of the axilla in women with operable breast cancer during the era of adoption of sentinel lymph node biopsy (SLNB) were studied.Women with operable breast carcinoma residing in 14 geographic areas of the Surveillance, Epidemiology, and End Results (SEER) cancer registries (1998-2004, n = 239,661) were assessed for axillary surgical patterns of care.Use of SLNB increased from 11 to 59%. Use of no axillary surgery decreased from 14 to 6.6%. In pathologic node-negative women, use of axillary lymph node dissection (ALND) decreased from 94 to 36%. Independent factors most associated with failure to receive SLNB included diagnosis year (2000: 62%; 2004: 29%), surgery (mastectomy: 64%; breast-conserving surgery: 36%), tumor size (T3: 71%; T2: 56%; T1: 40%), age (a parts per thousand yen70 years: 50%; < 70 years: 45%), grade (high: 42%; low: 38%), urbanity (non-large metropolitan area: 49%; large metropolitan area: 42%), and, by quartile, poverty (highest: 47%; lowest: 35%), and white-collar employment (lowest: 56%; highest: 47%). In pathologic node-positive women who had SLNB, failure to undergo completion ALND increased from 20% in 1998 to 32% in 2004. Patients with smaller, lower-grade tumors, and those with smaller size of nodal metastasis, lack of extracapsular extension, age a parts per thousand yen70 years, increased linguistic isolation, African-American or Hispanic race/ethnicity, and white-collar employment were less likely to undergo completion ALND.Management of the axilla changed dramatically during the period of rapid adoption of SLNB. Patterns of care suggest both appropriate and inappropriate selection for SLNB and ALND.