乳腺癌腋窝处理进展及策略

Progress and strategy for axillary management of breast cancer

随着对乳腺癌生物学特性的逐步认知、阐明及系统治疗的进一步完善,目前乳腺癌的治疗理念产生了颠覆性转变。其中,腋窝淋巴结处理策略也不断发生着变化。围绕这些理念的转变,大量相关临床试验也逐步开展,NSABP B04研究率先发起了对乳腺癌经典治疗术式中腋窝处理策略转变的探索。尽管该研究并没有改变当时腋窝处理的临床实践,但为后续一系列保留腋窝的临床研究提供了前期数据基础。在这些变迁中,前哨淋巴结活检作为乳腺癌外科治疗中里程碑式的进展,已经成为目前腋窝阴性患者的标准分期术式。此后,还展开了一系列相关临床研究,其中对低负荷腋窝转移患者研究的结果证实了部分患者保留腋窝的可行性,并由此影响和改变了临床实践。此外,新辅助治疗后进一步保留腋窝的研究结果,使部分患者新辅助治疗后保留腋窝成为可能,有效减少了术后上肢水肿。在该研究领域中,同等生存获益的前提下能否完全豁免腋窝手术,以及有关新辅助治疗后腋窝阳性患者是否可以豁免腋窝清扫等热议话题,也都在临床试验探讨中受到广泛关注与期待。

With the understanding of the biological characteristics of breast cancer and the improvement of systemic treatment,the treatment concept of breast cancer has changed,and the treatment strategy of axillary lymph nodes has also been constantly changing.With the change of these concepts,a large number of relevant clinical trials have been gradually carried out.The NSABP B04 study took the lead in exploring the transformation of axillary treatment strategies in the classic breast cancer treatment.Although this study did not change the clinical practice of axillary treatment at the time,it provided a preliminary data basis for a subsequent series of clinical studies on axillary preservation.In these changes,sentinel lymph node biopsy,as a milestone in the surgical treatment of breast cancer,has become the standard staging procedure for axillary negative patients.Since then,a series of related clinical studies have also been carried out,among which the results of studies on patients with low-load axillary metastasis have confirmed the feasibility of axillary preservation in some patients,which has influenced and changed clinical practice.In addition,the results of the study make it possible for some patients to preserve the axilla after neoadjuvant therapy reduce postoperative upper extremity edema effectively.Whether axillary surgery can be completely eliminated,and whether axillary dissection can be waived for patients with positive axilla after neoadjuvant therapy under the premise of equal survival benefit have also received extensive attention.