Axillary Dissection and Nodal Irradiation Can Be Avoided for Most Node-positive Z0011-eligible Breast Cancers: A Prospective Validation Study of 793 Patients.
Axillary Dissection and Nodal Irradiation Can Be Avoided for Most Node-positive Z0011-eligible Breast Cancers: A Prospective Validation Study of 793 Patients.
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DOI：
10.1097/sla.0000000000002354
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发表时间：
2017-09
影响因子：
9
通讯作者：
Cody HS
中科院分区：
文献类型：
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作者：
Morrow M;Van Zee KJ;Patil S;Petruolo O;Mamtani A;Barrio AV;Capko D;El-Tamer M;Gemignani ML;Heerdt AS;Kirstein L;Pilewskie M;Plitas G;Sacchini VS;Sclafani LM;Ho A;Cody HS
确定符合ACOSOG Z 0011标准的患者的腋窝淋巴结清扫（ALND）率和淋巴结复发率。Z 0011证明，cT 1 - 2N 0乳腺癌和1-2个受累前哨淋巴结（SLN）的患者接受保乳治疗（BCT）后，单独SLN活检或ALND后的局部复发或生存率无差异。结果的普遍性和淋巴结放射治疗（RT）的重要性尚不清楚。符合Z 0011标准的患者仅行SLN活检。前瞻性定义的ALND适应症为≥3个SLN的转移或大体囊外扩展。腋窝成像不是常规检查。SLN和ALND组及照射野比较采用卡方检验和t检验。采用竞争风险分析估计复发的累积发生率。从2010年8月至2016年12月，793例患者符合Z 0011合格性标准并发生SLN转移。130例（16%）患有ALND; ALND不因年龄、雌激素受体、孕激素受体或HER 2状态而异。5-单纯SLN术后1年无事件生存率为93%，无孤立性腋窝复发。乳腺+淋巴结和淋巴结+远处复发的5年累积率均为0.7%。在484例仅SLN患者中，已知RT野（103例俯卧位，280例仰卧位切线，101例乳腺+淋巴结），随访≥12个月，5年累积淋巴结复发率为1%，不同RT野无显著差异。我们证实，即使没有术前腋窝成像或常规使用淋巴结RT，ALND可以避免在绝大多数Z 0011合格的患者具有良好的区域控制。这种方法有可能使大量妇女免于ALND的发病率。
To determine rates of axillary dissection (ALND) and nodal recurrence in patients eligible for ACOSOG Z0011. Z0011 demonstrated that patients with cT1-2N0 breast cancers and 1–2 involved sentinel lymph nodes (SLNs) having breast-conserving therapy (BCT) had no difference in locoregional recurrence or survival after SLN biopsy alone or ALND. The generalizability of the results and importance of nodal radiotherapy (RT) is unclear. Patients eligible for Z0011had SLN biopsy alone. Prospectively defined indications for ALND were metastases in ≥3 SLNs or gross extracapsular extension. Axillary imaging was not routine. SLN and ALND groups and radiation fields were compared with chi-square and t-tests. Cumulative incidence of recurrences was estimated with competing risk analysis. From 8/2010–12/2016, 793 patients met Z0011 eligibility criteria and had SLN metastases. 130 (16%) had ALND; ALND did not vary based on age, estrogen receptor, progesterone receptor, or HER2 status. 5-year event-free survival after SLN alone is 93% with no isolated axillary recurrences. Cumulative 5-year rates of breast+nodal and nodal+distant recurrence were each 0.7%. In 484 SLN-only patients with known RT fields (103 prone, 280 supine tangent, 101 breast+nodes) and follow-up≥12 months, the 5-year cumulative nodal recurrence rate was 1% and did not differ significantly by RT fields. We confirm that even without preoperative axillary imaging or routine use of nodal RT, ALND can be avoided in a large majority of Z0011-eligible patients with excellent regional control. This approach has the potential to spare substantial numbers of women the morbidity of ALND.