How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study.
How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study.
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DOI：
10.1245/s10434-016-5246-8
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发表时间：
2016-10
影响因子：
3.7
通讯作者：
Morrow M
中科院分区：
文献类型：
--
作者：
Mamtani A;Barrio AV;King TA;Van Zee KJ;Plitas G;Pilewskie M;El-Tamer M;Gemignani ML;Heerdt AS;Sclafani LM;Sacchini V;Cody HS 3rd;Patil S;Morrow M
在表现为淋巴结转移的乳腺癌患者中，当≥3个阴性前哨淋巴结（SLN）时，新辅助化疗（NAC）后前哨淋巴结活检（SLNB）的假阴性率<10%，但可以避免腋窝淋巴结清扫（ALND）的频率尚不确定。在2013年11月至2015年11月期间接受NAC治疗的534例前瞻性确定的临床II-III期癌症连续患者中，确定了所有活检证实的淋巴结阳性（N+）病例。NAC后临床淋巴结阴性的患者符合SLNB资格。ALND适用于标测失败、取出<3个SLN或阳性SLN。在288例N+患者中，195例完成了手术。132/195例（68%）符合SLNB资格。其中，中位年龄为50岁，73例（55%）为ER+，21例（16%）为ER−/HER 2+，38例（29%）为三阴性。4例术中延迟SLNB。在128次SLNB尝试中，110次（86%）获得了≥3个SLN，15次（12%）获得了1-2个SLN，3次（2%）失败。66例有ALND指征，其中阳性54例（82%），阴性<3例9例（14%），标测失败3例（4%）。17%的<3个阴性前哨淋巴结的患者存在持续性疾病。62/128例（48%）仅SLNB，取出≥3枚SLN。在完成手术的195例N+患者中，49%的患者实现了淋巴结病理完全缓解（pCR），范围从ER+/HER 2 −的21%到ER−/HER 2+病例的97%，并且在ER+/HER 2 −和三阴性病例中显著高于乳腺pCR。近70%的N+患者在NAC后符合SLNB条件。48%的患者避免了ALND，支持NAC在降低淋巴结转移患者ALND需求方面的作用。
In breast cancer patients with nodal metastases at presentation, false-negative rates <10% have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when ≥3 negative sentinel nodes (SLNs) are retrieved, but the frequency with which axillary dissection (ALND) can be avoided is uncertain. Among 534 prospectively identified consecutive patients with clinical stage II–III cancer receiving NAC from 11/2013–11/2015, all biopsy-proven node-positive (N+) cases were identified. Patients who were clinically node-negative post-NAC were SLNB-eligible. ALND was indicated for failed mapping, <3 SLNs retrieved, or positive SLNs. Of 288 N+ patients, 195 completed surgery. 132/195 (68%) were SLNB-eligible. Of these, median age was 50yrs, 73(55%) were ER+, 21(16%) ER−/HER2+, 38(29%) triple negative. SLNB was deferred intraoperatively in 4 cases. Among 128 SLNB attempts, ≥3 SLNs were retrieved in 110 (86%), 1–2 SLNs in 15(12%), 3 (2%) failed mapping. ALND was indicated in 66 cases: 54(82%) for positive SLNs, 9(14%) for <3 negative SLNs, 3(4%) for failed mapping. 17% with <3 negative SLNs retrieved had persistent disease. 62/128 (48%) had SLNB alone with ≥3 SLNs retrieved. Among 195 N+ patients completing surgery, nodal pathologic complete response (pCR) was achieved in 49%, ranging from 21% in ER+/HER2− to 97% in ER−/HER2+ cases, and was significantly more common than breast pCR in ER+/HER2− and triple-negative cases. Nearly 70% of N+ patients were SLNB-eligible post-NAC. ALND was avoided in 48%, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases.
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DOI：
10.1016/s1470-2045(14)70460-7
发表时间：
2014-11
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Donker M;van Tienhoven G;Straver ME;Meijnen P;van de Velde CJ;Mansel RE;Cataliotti L;Westenberg AH;Klinkenbijl JH;Orzalesi L;Bouma WH;van der Mijle HC;Nieuwenhuijzen GA;Veltkamp SC;Slaets L;Duez NJ;de Graaf PW;van Dalen T;Marinelli A;Rijna H;Snoj M;Bundred NJ;Merkus JW;Belkacemi Y;Petignat P;Schinagl DA;Coens C;Messina CG;Bogaerts J;Rutgers EJ
通讯作者：
Rutgers EJ
影响因子：
45.3
作者：
Hennessy, BT;Hortobagyi, GN;Valero, V
通讯作者：
Valero, V
影响因子：
120.7
作者：
Boughey, Judy C.;Suman, Vera J.;Mittendorf, Elizabeth A.;Ahrendt, Gretchen M.;Wilke, Lee G.;Taback, Bret;Leitch, A. Marilyn;Kuerer, Henry M.;Bowling, Monet;Flippo-Morton, Teresa S.;Byrd, David R.;Ollila, David W.;Julian, Thomas B.;McLaughlin, Sarah A.;McCall, Linda;Symmans, W. Fraser;Le-Petross, Huong T.;Haffty, Bruce G.;Buchholz, Thomas A.;Nelson, Heidi;Hunt, Kelly K.
通讯作者：
Hunt, Kelly K.
影响因子：
45.3
作者：
Mamounas, Eleftherios P.;Anderson, Stewart J.;Wolmark, Norman
通讯作者：
Wolmark, Norman
影响因子：
3.8
作者：
Goyal, Amit;Newcombe, Robert G.;Mansel, Robert E.
通讯作者：
Mansel, Robert E.