乳腺癌病人前哨淋巴结1~2枚转移、未行腋窝淋巴结清扫：影响因素和预后

doi:10.16139/j.1007-9610.2019.05.012

摘要/Abstract

摘要： 目的：对于满足ACOSOG Z0011入组条件的1~2枚前哨淋巴结（sentinel lymph node, SLN）转移病人,分析影响其未行腋窝淋巴结清扫（axillary lymph node dissection, ALND）的相关因素及其对预后的价值。方法：回顾性分析2012年1月至2019年8月在我院乳腺疾病诊治中心接受手术的cT_1-2N₀、计划接受保乳和放疗的浸润性乳腺癌病人,分析SLN 1~2枚转移病人未行进一步ALND的影响因素,并评估该治疗方式对预后的影响。结果：用优势比（odds ratio,OR）以及95%CI表示。结果：共有161例病人入组,SLN活检（SLNB）组（未行ALND）和ALND组病人分别为78和83例。ALND组11（13.3%）例发现有非SLN转移,4（4.8%）例有3枚ALN转移。单因素及多因素分析均提示,手术年份是行ALND的影响因素（P<0.001）。手术年份近的病人,更多选择不行ALND。SLNB组和ALND组分别有11例（14.1%）和6例（3.6%）病人未接受辅助化疗。单因素分析发现术后辅助化疗与年龄（P<0.001）、月经状态（P=0.016）和ALN手术（P=0.018）相关。多因素分析显示,影响化疗的独立因素为年龄(P<0.001)。中位随访42.0个月,发现SLNB组1例（1.3%）ALN复发,ALND组无ALN复发。结论：对于SLN 1~2枚转移且满足ACOSOG Z0011试验入组条件的病人,可以不行ALND。ALND手术与预后的关系,有待进一步研究证实。

关键词: 乳腺癌, 前哨淋巴结转移, 腋窝淋巴结清扫, 影响因素, 预后

Abstract: Objective To analyze the factors influencing breast cancer patients with 1-2 positive sentinel lymph nodes which meets ACOSGO Z0011 criteria without further axillary lymph node dissection (ALND) and their prognosis. Methods Patients with cT_1-2N₀ invasive breast cancer received breast conserving surgery and radiotherapy were enrolled retrospectively in Comprehensive Breast Health Center, Rujin Hospital between January 2012 and August 2019. Factors which influenced not to receive further ALND in patients with 1-2 positive sentinel lymph node and its association with prognosis were analyzed. Results were listed as odds ratio and 95% confidence interval. Results A total of 161 patients were studied, including 78 patients without ALND in the SLNB group and 83 patients in the ALND group. There were 11 (13.3%) patients with non-SLN metastasis and 4 (4.8%) patients with 3 axillary lymph node (ALN) metastasis in the ALND group. Both univariate and multivariate analysis found that surgical-year was associated with ALND (P<0.001). Patients in more recent surgical-year were received less ALND. Eleven (14.1%) and 6 (3.6%) patients in the SLNB and ALND groups had no further adjuvant chemotherapy, respectively. Univariate analysis showed that age (P<0.001), menopausal status (P=0.016), and ALN surgery(P=0.018) were related with adjuvant chemotherapy. Multivariate analysis showed that only age was independently related with chemotherapy(P<0.001). With a median follow up of 42.0 months, ALN recurrence was found only 1 (1.3%) patient in the SLNB group and none in the ALND group. Conclusions Patients with 1-2 positive sentinel nodes who met the eligible criteria of ACOSOG Z0011 trial could be treated without ALND. The association of ALND with long-term survival deserves further evaluation.

Key words: Breast cancer, Sentinel lymph node metastasis, Axillary lymph node dissection, Influencing factors, Prognosis

中图分类号:

R737.9

陈小松, 吴佳毅, 黄欧, 何建蓉, 朱丽, 李亚芬, 陈伟国, 沈坤炜. 乳腺癌病人前哨淋巴结1~2枚转移、未行腋窝淋巴结清扫：影响因素和预后[J]. 外科理论与实践, 2019, 24(05): 428-433.

CHEN Xiaosong, WU Jiayi, HUANG Ou, HE Jianrong, ZHU Li, LI Yafen, CHEN Weiguo, SHEN Kunwei. Breast cancer patients with 1-2 positive sentinel lymph nodes without axillary lymph node dissection: influencing factors and prognosis[J]. Journal of Surgery Concepts & Practice, 2019, 24(05): 428-433.

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