Age and Receptor Status Do Not Indicate the Need for Axillary Dissection in Patients with Sentinel Lymph Node Metastases
Age and Receptor Status Do Not Indicate the Need for Axillary Dissection in Patients with Sentinel Lymph Node Metastases
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DOI：
10.1245/s10434-016-5259-3
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发表时间：
2016-10-01
影响因子：
3.7
通讯作者：
Morrow, Monica
中科院分区：
文献类型：
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作者：
Mamtani, Anita;Patil, Sujata;Morrow, Monica
美国外科医师学会肿瘤组Z 0011试验证明了对接受保乳治疗（BCT）的前哨淋巴结（SLN）阳性少于3个的女性省略腋窝淋巴结清扫（ALND）的安全性。由于大多数女性为绝经后雌激素受体（ER）阳性癌症患者，ALND对年轻患者和三阴性（TN）或人表皮生长因子受体2（HER 2）过表达（HER 2+）肿瘤患者的适用性仍存在争议。从2010年8月至2015年1 - 2月，前瞻性随访了因cT 1 - 2N 0疾病接受BCT并发现SLN阳性的患者。腋窝淋巴结清扫适用于两个以上阳性SLN或大体囊外延伸。比较高危患者的临床病理特征、腋窝手术、淋巴结负荷和预后在701名连续患者中，242名（35%）为高风险患者：31例（13%）TN，48例（20%）HER 2+，130例（54%）年龄小于50岁，33例（14%）具有一种以上的高风险特征。其余459例患者（65%）为平均风险。高风险患者更年轻，肿瘤分级更高（p < 0.0001），并且更经常有异常淋巴结成像（p = 0.02）。在本研究中，85%的高风险病例与82%的平均风险病例单独进行了SLNB（p = 0.39）。切除的前哨淋巴结中位数为4个与3个（p = 0.04），两组的前哨淋巴结中位数均为1个阳性。在ALND中，62%的高风险患者与65%的平均风险患者发现了额外的阳性淋巴结（p = 0.8），两组中的中位数为3个阳性淋巴结。在平均31个月的随访期内，没有患者出现孤立性腋窝复发，高危患者不太可能接受腋窝淋巴结清扫术。对于接受ALND的患者，淋巴结负荷相似。对于符合美国外科医师学会肿瘤组（ACOSOG）Z 0011临床合格性标准的患者，ALND不适用于年龄或亚型。
The American College of Surgeons Oncology Group Z0011 trial demonstrated the safety of omitting axillary lymph node dissection (ALND) for women with fewer than three positive sentinel lymph nodes (SLNs) who are undergoing breast-conservation therapy (BCT). Because most of the women were postmenopausal with estrogen receptor (ER) positive cancers, applicability of ALND for younger patients and those with triple-negative (TN) or human epidermal growth factor receptor 2 (HER2) overexpressing (HER2+) tumors remains controversial.From August 2010 to December 2015, patients undergoing BCT for cT1-2N0 disease and found to have positive SLNs were prospectively followed. Axillary lymph node dissection was indicated for more than two positive SLNs or gross extracapsular extension. Clinicopathologic characteristics, axillary surgery, nodal burden, and outcomes were compared between the high-risk patients (TN, HER2+, or age < 50 years) and the remaining patients, termed average risk patients.Among 701 consecutive patients, 242 (35 %) were high risk: 31 (13 %) with TN, 48 (20 %) with HER2+, 130 (54 %) with age less than 50 years, and 33 (14 %) with more than one high-risk feature. The remaining 459 patients (65 %) were average risk. The high-risk patients were younger, had higher-grade tumors (p < 0.0001), and more often had abnormal nodes imaged (p = 0.02). In this study, SLNB alone was performed for 85 % high-risk versus 82 % average-risk cases (p = 0.39). A median of four versus three SLNs were excised (p = 0.04), and both groups had a median of one positive SLN. Additional positive nodes at ALND were found in 62 % high-risk patients versus 65 % average-risk patients (p = 0.8), with a median of three positive nodes in both groups. During a median follow-up period of 31 months, no patients experienced isolated axillary recurrences.Axillary lymph node dissection was no more likely to be indicated for high-risk patients. For patients undergoing ALND, the nodal burden was similar. For patients otherwise meeting the American College of Surgeons Oncology Group (ACOSOG) Z0011 clinical eligibility criteria, ALND is not indicated on the basis of age or subtype.