摘要
背景与目的:前哨淋巴结活检(sentinel lymph node biopsy,SLNB)是临床淋巴结阴性(clinically nodenegative,cN_0)早期乳腺癌患者诊断的标准,但对于新辅助化疗(neoadjuvant chemotherapy,NAC)的cN_0患者行SLNB的时机仍存在争议。本研究旨在探讨cN_0患者接受NAC与SLNB的最佳时机,评估其NAC后选择性避免腋窝手术的可行性。方法:回顾性分析2010年10月—2018年4月山东大学附属山东省肿瘤医院乳腺病中心收治的809例行NAC患者的临床病理学资料,分析138例cN_0患者的不同临床病理学特征与NAC后腋窝淋巴结阴性(即ypN0)的相关性。结果:cN_0患者NAC后81.9%(113/138)为ypN0。激素受体(hormone receptor positive,HR)阳性(+)/人表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)阴性(-)、HR+/HER2+、HR-/HER2+,以及三阴性乳腺癌(triple-negative breast cancer,TNBC)患者NAC后ypN0率分别为75.4%(46/61)、81.0%(17/21)、79.2%(19/24)和96.9%(31/32)(P<0.001)。HER2+患者接受靶向治疗、TNBC患者接受NAC后,ypN0率分别为94.1%(16/17)、96.9%(31/32),较HR+/HER2-患者显著增高(均P<0.05)。乳房肿瘤的分子分型、临床分期、影像学完全缓解及病理完全缓解(breast pathologic complete response,bpCR)与NAC(行全疗程化疗)后ypN0显著相关(P均<0.05),其中乳房肿瘤的分子分型(OR=0.454, P=0.049)、临床分期(OR=3.174,P=0.029)和bpCR(OR=0.337,P=0.016)是NAC后ypN0的独立预测因素。结论:不同分子分型cN_0患者NAC与SLNB的最佳时机不同:HR+/HER2-患者接受NAC前行SLNB可降低腋窝淋巴结清扫(axillary lymph node dissection,ALND)的风险,而HER2+患者接受靶向治疗和TNBC患者NAC后行SLNB能更好地避免ALND。鉴于cN_0患者NAC后的高ypN0率,尤以HER2+行靶向治疗及TNBC患者为著,使其NAC后选择性避免腋窝手术成为可能。
Background and purpose:Sentinel lymph node biopsy(SLNB)is regarded as the standard of care in patients with clinically node-negative(cN0)disease in early-stage breast cancer,but the timing of SLNB and neoadjuvant chemotherapy(NAC)in cN0 patients is still controversial.This study aimed to explore the optimal timing of SLNB and NAC,and to assess the feasibility of selective elimination of axillary surgery after NAC in cN0 patients.Methods:From Oct.2010 to Apr.2018,809 patients who underwent surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN0 patients and negative axillary lymph node conversion after NAC(ie,ypN0).Results:Among the 138 cN0 patients receiving NAC,81.9%(113/138)were ypN0.The rates of ypN0 after NAC in patients with hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2^-),HR^+/HER2^+,HR^-/HER2^+and triple-negative breast cancer(TNBC)were 75.4%(15/61),81.0%(17/21),79.2%(19/24)and 96.9%(31/32),respectively(P﹤0.001).The rates of ypN0 after NAC in patients with HER2+(with targeted therapy)and TNBC were 94.1%(16/17)and 96.9%(31/32),respectively,which were significantly higher than that in HR^+/HER2^-patients(P﹤0.05).Molecular subtypes,clinical stage,radiologic complete response and pathologic complete response(bpCR)of the breast tumor correlated with ypN0 after NAC(with full-course chemotherapy,P﹤0.05).Molecular subtypes(OR=0.454,P=0.049),clinical stage(OR=3.174,P=0.029)and bpCR(OR=0.337,P=0.016)of the breast tumor were independent predictors for ypN0 after NAC.Conclusion:The optimal timing of SLNB and NAC in cN0 patients might be different among different molecular subtypes.It would be preferable to perform SLNB prior to NAC for HR+/HER2-patients,and SLNB after NAC for HER2^+(with targeted therapy)and TNBC patients to reduce the risk of axillary lymph node dissection(ALND).In view of the high ypN0 rate after NAC in cN0 patients,axillary surgical staging might be selectively eliminated,especially in patients with HER2^+(with targeted therapy)and TNBC.
作者
石志强
邱鹏飞
丛斌斌
刘雁冰
毕钊
郑卫真
东野羽玺
杨然
王永胜
SHI Zhiqiang;QIU Pengfei;CONG Binbin;LIU Yanbing;BI Zhao;ZHENG Weizhen;DONGYE Yuxi;YANG Ran;WANG Yongsheng(Cheeloo College of Medicine,Shandong University,Jinan 250012,Shandong Province,China;Breast Cancer Center,Shandong Cancer Hospital Affiliated to Shandong University,Jinan 250117,Shandong Province,China;School of Medicine and Life Science,Shandong Academy of Medical Sciences,University of Jinan,Jinan 250200,Shandong Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2018年第12期922-927,共6页
China Oncology
基金
国家自然科学基金(81502314)
山东省医药卫生科技发展计划项目(2016WS0549)
关键词
乳腺癌
新辅助化疗
临床淋巴结阴性
前哨淋巴结活检
Breast cancer
Neoadjuvant chemotherapy
Clinically node-negative disease
Sentinel lymph node biopsy
