人表皮生长因子受体2阳性和三阴性乳腺癌患者新辅助化疗后腋窝淋巴结病理学分析

Pathology of axillary lymph nodes after neoadjuvant chemotherapy for human epidermal growth factor receptor 2-positive and triple-negative breast cancer patients

目的探讨人表皮生长因子受体2(HER2)阳性和三阴性乳腺癌患者新辅助化疗后腋窝淋巴结病理学情况,并分析HER2阳性和三阴性乳腺癌患者新辅助化疗后腋窝淋巴结病理学阳性(ypN0)的影响因素。方法回顾性分析2019年9月至2022年1月西安国际医学中心医院收治的72例HER2阳性和三阴性乳腺癌患者的临床资料,其中HER2阳性乳腺癌患者35例,三阴性乳腺癌患者37例。根据患者新辅助化疗后腋窝淋巴结病理学分为ypN0组(n=41)和非ypN0组(n=31)。比较2组患者的绝经情况、病理类型、乳腺癌类型、新辅助化疗疗程、肿瘤最大直径、新辅助化疗前肿瘤分期、新辅助化疗前淋巴结分期、新辅助化疗后乳房影像学完全缓解(brCR)情况、新辅助化疗后淋巴结临床阴性(cN0)情况、新辅助化疗后原发肿瘤病理学完全缓解(pCR)情况,采用多因素logistic回归分析HER2阳性和三阴性乳腺癌患者新辅助化疗后ypN0的独立影响因素,分析新辅助化疗前淋巴结分期cN0、cN1(临床淋巴结阳性)患者新辅助化疗后ypN0情况。结果ypN0组与非ypN0组患者的绝经情况、病理类型、乳腺癌类型、新辅助化疗疗程、肿瘤最大直径比较差异无统计学意义(P>0.05);ypN0组与非ypN0组患者新辅助化疗前肿瘤分期、淋巴结分期及新辅助化疗后原发肿瘤影像学检查显示brCR情况、淋巴结检查显示cN0情况、原发肿瘤pCR情况比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,新辅助化疗前淋巴结分期、新辅助化疗后淋巴结cN0、新辅助化疗后原发肿瘤pCR是HER2阳性和三阴性乳腺癌患者新辅助化疗后ypN0的独立影响因素(P<0.05)。14例新辅助化疗前淋巴结分期cN0患者,新辅助化疗后6例获得pCR、8例未获得pCR。获得pCR和未获得pCR患者的ypN0率分别为100%(6/6)、75%(6/8),获得pCR患者和未获得pCR患者的ypN0率比较差异无统计学意义(χ^(2)=1.750,P=0.186)。33例新辅助化疗前淋巴结分期为cN1患者,新辅助化疗后10例获得pCR、23例未获得pCR。获得pCR和未获得pCR患者的ypN0率分别为100.00%(10/10)、39.13%(9/23),获得pCR患者的ypN0率高于未获得pCR患者(χ^(2)=10.572,P=0.001)。结论HER2阳性和三阴性乳腺癌患者新辅助化疗前淋巴结分期、新辅助化疗后淋巴结cN0、新辅助化疗后原发肿瘤pCR与腋窝淋巴结病理学有关,新辅助化疗后pCR的cN0及部分cN1的HER2阳性和三阴性乳腺癌患者腋窝转移风险低,可考虑腋窝降阶梯手术。

Objective To investigate the pathology of axillary lymph nodes after neoadjuvant chemotherapy(NAC)for human epidermal growth factor receptor 2(HER2)positive and triple-negative breast cancer and analyze the influencing factors of pathologically positive(ypN0)axillary lymph nodes.Methods The clinical data of 72 patients with HER2-positive and triple-negative breast cancer admitted to the Xi′an International Medical Center Hospital from September 2019 to January 2022 were retrospectively analyzed,including 35 patients with HER2-positive breast cancer and 37 patients with triple-negative breast cancer.According to the pathology of axillary lymph nodes after NAC,the patients were divided into the ypN0 group(n=41)and the non-ypN0 group(n=31).The menopausal status,pathological type,breast cancer type,NAC duration,maximum tumor diameter,tumor staging before NAC,lymph node staging before NAC,breast radiologic complete response(brCR)after NAC,clinically negative lymph node(cN0)after NAC,and pathologic complete response(pCR)of primary tumor after NAC were compared between the two groups.The independent factors influencing ypN0 after NAC in HER2-positive and triple-negative breast cancer patients were analyzed using the multivariate logistic regression,and the ypN0 status of patients with lymph node stages cN0 and cN1 before NAC was also analyzed.Results There were no significant differences in menopausal status,pathological type,breast cancer type,NAC duration and maximum tumor diameter between the ypN0 group and the non-ypN0 group(P>0.05).There were statistically significant differences between the ypN0 group and the non-ypN0 group in tumor staging before NAC,lymph node staging before NAC,brCR of primary tumor after NAC,cN0 after NAC,and pCR of primary tumor after NAC(P<0.05).The multivariate logistic regression analysis showed that lymph node staging before NAC,lymph node cN0 after NAC,and pCR of primary tumor after NAC were independent factors affecting ypN0 after NAC in HER2-positive and triple-negative breast cancer patients(P<0.05).Among the 14 cN0 patients before NAC,6 achieved pCR and 8 did not achieve pCR after NAC.The ypN0 rate between patients who achieved pCR[100%(6/6)]and patients who did not achieve pCR[75%(6/8)]after NAC had no significant difference(χ^(2)=1.750,P=0.186).Among the 33 cN1 patients before NAC,10 achieved pCR and 23 did not achieve pCR after NAC.The ypN0 rate in patients with pCR after NAC[100%(10/10)]was higher than that in patients without pCR[39.13%(9/23)](χ^(2)=10.572,P=0.001).Conclusion For HER2-positive and triple-negative breast cancer patients,the lymph node staging before NAC,lymph node cN0 after NAC,and primary tumor pCR after NAC are related to the pathology of axillary lymph nodes.All cN0 patients and some cN1 patients with pCR after NAC have a low risk of axillary metastasis,and axillary de-escalation surgery can be considered.