Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer.
Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer.
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DOI：
10.2325/jbcs.14.16
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Tabei, Toshio
中科院分区：
文献类型：
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作者：
Takei, Hiroyuki;Suemasu, Kimito;Tabei, Toshio
背景：乳腺癌患者单独进行前哨淋巴结活检(SLNB)后，区域淋巴结复发是一个主要问题。资料与方法：1999年1月至2005年3月，在同一研究所(崎玉癌症中心)，对1,670例(34例双侧乳腺癌)临床阴性或可疑转移结节行SLNB治疗的1,704例乳腺癌患者进行了研究。所有1704例患者都根据有无转移淋巴结进行分类，接受或不接受腋窝淋巴结清扫(ALND)治疗。首次复发的部位被归类为局部、区域或远处。结果：中位随访34个月(2~83个月)，局部复发32例(1.9%)，区域复发26例(1.5%)，远处复发61例(3.6%)。1062例淋巴结阴性患者和459例淋巴结阳性患者中，区域复发11例(1.0%)，腋窝复发4例(0.4%)，腋窝复发2例(0.6%)。822例淋巴结阴性的浸润性乳腺癌中，10例(1.4%)复发于区域淋巴结，4例(0.5%)复发于腋窝淋巴结。10例区域性淋巴结衰竭患者中，雌激素受体(ER)和/或孕激素受体(PR)均为阴性，核分级(NG)均为3级。结论：单纯SLNB治疗腋窝复发率低。在足够的SLNB后，省略ALND是安全的。单用SLNB后区域性结节衰竭的危险因素为激素受体状态阴性和高NG。
BACKGROUND: A regional nodal recurrence is a major concern after a sentinel lymph node biopsy (SLNB) alone in patients with breast cancer. In this study we investigated patterns and risk factors of regional nodal recurrence after SLNB alone.PATIENTS AND METHODS: Between January 1999 and March 2005, a series of 1,704 consecutive breast cancer cases in 1,670 patients (34 bilateral breast cancer cases) with clinically negative nodes or suspicious nodes for metastasis who underwent SLNB at a single institute (Saitama Cancer Center) were studied. All 1,704 cases were classified based upon presence or absence of a metastatic lymph node, treated with or without axillary lymph node dissection (ALND). The site of first recurrence was classified as local, regional node, or distant. The regional node recurrences were subclassified as axillary, interpectoral, infraclavicular, supraclavicular, or parasternal.RESULTS: After a median follow-up period of 34 months (range, 2-83 months), first recurrence occurred in local sites in 32 (1.9%) cases, regional nodes in 26 (1.5%) cases, and distant sites in 61 (3.6%) cases. In 1,062 cases with negative nodes treated without ALND and 459 cases with positive nodes treated with ALND, 11 (1.0%) and 15 (3.3%) recurred in regional nodes, respectively, and 4 (0.4%) and 2 (0.6%) recurred in axillary nodes, respectively. Of 822 cases of invasive breast cancer with negative nodes treated with SLNB alone, 10 (1.4%) recurred in regional nodes, and 4 (0.5%) recurred in axillary nodes. In the 10 patients with regional nodal failure, all of the tumors were negative for estrogen receptor (ER) and/or progesterone receptor (PR) and were nuclear grade (NG) 3.CONCLUSIONS: The axillary recurrence rate was low in patients treated with SLNB alone. Omitting ALND is concluded to be safe after adequate SLNB. Risk factors for regional nodal failure after SLNB alone are negative hormone receptor status and high NG.