1、2枚SLN阳性乳腺癌患者的NSLN转移预测

目的分析1、2枚前哨淋巴结(SLN)阳性乳腺癌患者的临床、病理特征与非前哨淋巴结(NSLN)转移的关系,验证纪念斯隆凯特琳癌症中心(MSKCC)NSLN转移预测模型的临床应用价值。方法选取2010年4月—2017年10月于吉林大学白求恩第一医院连续行前哨淋巴结活检证实的1、2枚SLN阳性,并进一步行腋窝淋巴结清扫术的乳腺癌患者294例。对符合纳入标准的患者临床病理资料进行单因素及多因素分析,探索其与NSLN转移的关系。利用MSKCC模型计算每个患者NSLN转移的预测值,通过受试者工作曲线及曲线下面积(AUC)评估其在患者中的应用价值。结果 294例患者中86例存在NSLN转移。脉管癌栓是否阳性、阳性SLN数/总SLN数比值比较,差异有统计学意义(P<0.05)。MSKCC预测模型对研究人群NSLN转移预测的AUC为0.643。结论 SLN转移率高或存在脉管癌栓的1、2枚SLN阳性的患者容易出现NSLN转移,MSKCC模型预测NSLN转移的准确性不佳。

Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.

应规范乳腺癌新辅助治疗后腋窝淋巴结的处理

新辅助治疗使部分乳腺癌患者的原发灶和腋窝转移淋巴结降期,为乳腺癌外科个体化治疗带来了新的挑战和机遇。前者为不可手术和不适合保留乳房手术的乳腺癌患者提供了手术的可能和保留乳房的机会,后者为前哨淋巴结活检代替腋窝淋巴结清扫提供了可能。但采用早期乳腺癌前哨淋巴结活检的技术和方法,新辅助治疗后前哨淋巴结活检的发现率和假阴性率难以达到临床要求。因此,新辅助治疗后的前哨淋巴结活检应由拥有先进的影像学设备、具有丰富的前哨淋巴结活检经验、能够对新辅助治疗前后的腋窝状况进行准确评估和对新辅助治疗前转移淋巴结进行标记的团队实施,适应证应严格限定在cN0期降至ycN0期和cN1期降至ycN0期的患者,尤其是对新辅助治疗后腋窝淋巴结转阴的病例,必须满足双示踪剂(蓝染料和放射性核素)、切除前哨淋巴结数目≥3枚、靶向腋窝淋巴结切除术3个条件,才能保证新辅助治疗后前哨淋巴结活检的安全正确实施。