乳腺癌腋窝反向淋巴作图联合术中冰冻切片分析的远期安全性

Long-term safety of axillary reverse lymphatic mapping combined with intraoperative frozen section analysis in breast cancer

目的:探讨腋窝反向淋巴作图(axillary reverse mapping,ARM)联合术中冰冻切片分析(intraoperative frozen section analysis,IFS)预防腋窝淋巴结清扫(axillary lymph node dissection,ALND)术后乳腺癌相关淋巴水肿(breast cancer-related lymphedema,BCRL)的远期安全性。方法:回顾性分析2017年1月—2019年6月在揭阳市人民医院住院治疗的103例乳腺癌患者的临床资料,根据乳腺癌改良根治术时腋窝手术方式的不同将患者分为对照组(常规ALND,53例)和实验组(ARM联合IFS,50例)。术后随访时间至2022年6月,比较对照组和实验组远期局部复发率、区域淋巴结复发率、无病生存率、总生存率、BCRL发生率、数字分级评分法疼痛评分等指标,评估ARM联合IFS的远期安全性及疗效。结果:对照组与实验组患者的年龄、体重指数、TNM分期、病理分级和免疫组化分型等差异均无统计学意义(P值均>0.05)。实验组的区域淋巴结复发率和BCRL发生率分别为0和16.0%,低于对照组的11.3%和37.7%(P值均<0.05)。实验组的疼痛评分也低于对照组(P<0.05)。两组远处转移率、胸壁局部复发率、无病生存率、总生存率等差异均无统计学意义(P值均>0.05)。结论:ARM联合IFS可以降低乳腺癌ALND术后区域淋巴结复发率,减少BCRL的发生风险,减轻术后疼痛,具有较好的安全性。

Objective:To investigate the long-term safety of axillary reverse lymphatic mapping(ARM)combined with intraoperative frozen section analysis(IFS)for the prevention of breast cancer-related lymphedema(BCRL)after axillary lymph node dissection(ALND).Methods:The clinical data of 103 breast cancer patients hospitalized in Jieyang People's Hospital from January 2017 to June 2019 were retrospectively analyzed,and the patients were divided into a control group(conventional ALND,53 cases)and an experimental group(ARM combined with IFS,50 cases)according to the different axillary surgical approaches at the time of modified radical mastectomy for breast cancer.The postoperative follow-up period was until June 2022,and the long-term local recurrence rate,regional lymph node recurrence rate,disease-free survival rate,overall survival rate,BCRL incidence rate,and pain score by numeral rating scale were compared between the control and experimental groups to evaluate the long-term safety and efficacy of ARM combined with IFS.Results:There were no statistically significant differences in age,body mass index,TNM stage,pathological grading and immunohistochemical typing between the control and experimental groups of patients(all P>0.05).The regional lymph node recurrence rate and the incidence of BCRL in the experimental group were 0 and 16.0%,respectively,which were lower than those of 11.3%and 37.7%in the control group(both P<0.05).The pain scores in the experimental group were also lower than those in the control group(P<0.05).The differences in distant metastasis rate,chest wall local recurrence rate,disease-free survival rate,and overall survival rate between the two groups were not statistically significant(all P>0.05).Conclusion:ARM combined with IFS can reduce the rate of regional lymph node recurrence after ALND for breast cancer,reduce the risk of BCRL,and alleviate postoperative pain,with a better safety profile.