The prevalence of non-sentinel lymph node metastasis among breast cancer patients with sentinel lymph node involvement and its impact on clinical decision-making: a single-centred retrospective study.

IF 3.1 Q2 ONCOLOGY
Oncology Reviews Pub Date : 2024-10-31 eCollection Date: 2024-01-01 DOI:10.3389/or.2024.1495133
Jingxian Ding, Xiaoliu Jiang, Zhaohui Huang, Qiao Ji, Jie Long, Yali Cao, Yonghong Guo
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引用次数: 0

Abstract

Background: Sentinel lymph node biopsy (SLNB) has become standard procedure for early breast cancer patients with clinically node negative disease. The patients with SLN metastasis normally underwent axillary lymph node dissection (ALND). However, the metastatic status of non-sentinel Lymph nodes (non-SLNs) varied significantly in different reports. Here, we evaluated the prevalence of non-SLNs metastasis among breast cancer patients with sentinel lymph node metastasis and its impact on clinical decision-making.

Materials and methods: We identified 892 female patients with operable cT1-3N0 invasive breast cancer who underwent ALND in our center due to SLN metastasis from 2017 to 2023, retrospectively. The prevalence of non-SLN metastasis among different clinicopathological traits and its correlation with the number of positive SLNs were analyzed. The optimal clinical decision-making was generalized.

Results: The median number of SLN+, SLN, non-SLN+ and non-SLN was 2, 4, 1 and 14 among the enrolled 892 female patients, respectively. 504 (56.50%) patients with SLN + had at least one metastatic lymph node in the harvested non-SLNs. Among the enrolled 892 female patients, 435 (48.77%) patients with 1 positive SLN, of which 180 (41.38%) had at least one additional metastatic non-SLNs. 242 (27.13%) patients with 2 positive SLNs, of which 146 (60.33%) had at least one metastatic non-SLNs. For the rest 215 (24.10%) patients with at least 3 metastatic SLNs, 178 (82.79%) had at least one metastatic non-SLNs. In the univariate analysis, the non-SLNs metastatic status was correlated with the number of SLNs+, tumor size, tumor grade, lymphovascular invasion (LVI) and molecular subtypes, but not histopathologic type. In the multivariate analysis, the risk of additional non-SLNs metastasis correlated with the number of SLNs+, SLNs, non-SLNs and LVI.

Conclusion: Omiting ALND in patients with higher non-SLNs + rate outside the American College of Surgeons Oncology Group (ACSOG) Z0011 and the European Organization for Research and Treatment of Cancer (EORTC) 10,981-22023 AMAROS criteria should be considered with caution in clinical decision-making. To evaluate whether axillary radiotherapy and ALND provides equivalent regional control in breast cancer patients with obvious residual metastatic lymph nodes undesected in the axilla, a well-matched prospective randomized controlled trial is an urgent need.

前哨淋巴结受累的乳腺癌患者中非前哨淋巴结转移的发生率及其对临床决策的影响:一项单中心回顾性研究。
背景:前哨淋巴结活检(SLNB)已成为临床结节阴性的早期乳腺癌患者的标准手术。有前哨淋巴结转移的患者通常会接受腋窝淋巴结清扫术(ALND)。然而,在不同的报告中,非前哨淋巴结(non-SLNs)的转移状态差异很大。在此,我们评估了前哨淋巴结转移的乳腺癌患者中非前哨淋巴结转移的发生率及其对临床决策的影响:我们对2017年至2023年在本中心因SLN转移而接受ALND的892例可手术的cT1-3N0浸润性乳腺癌女性患者进行了回顾性研究。分析了非SLN转移在不同临床病理特征中的发生率及其与SLN阳性数量的相关性。对最佳临床决策进行了归纳:入组的 892 名女性患者中,SLN+、SLN、非 SLN+ 和非 SLN 的中位数分别为 2、4、1 和 14。504例(56.50%)SLN+患者在收获的非SLN中至少有一个转移淋巴结。在登记的 892 名女性患者中,435 名(48.77%)患者有 1 个阳性 SLN,其中 180 名(41.38%)患者有至少一个额外的转移性非 SLN。242名(27.13%)患者有2个SLN阳性,其中146名(60.33%)患者至少有一个转移性非SLN。其余 215 名(24.10%)患者至少有 3 个转移性 SLN,其中 178 名(82.79%)患者至少有一个转移性非 SLN。在单变量分析中,非SLNs转移状态与SLNs+数量、肿瘤大小、肿瘤分级、淋巴管侵犯(LVI)和分子亚型相关,但与组织病理学类型无关。在多变量分析中,额外的非淋巴结转移风险与淋巴结数目+、淋巴结、非淋巴结和LVI相关:结论:对于非SLNs+率高于美国外科学院肿瘤学组(ACSOG)Z0011和欧洲癌症研究与治疗组织(EORTC)10,981-22023 AMAROS标准的患者,在临床决策中应慎重考虑放弃ALND。要评估腋窝放疗和ALND是否能为腋窝未检测到明显残留转移淋巴结的乳腺癌患者提供同等的区域控制效果,迫切需要进行匹配良好的前瞻性随机对照试验。
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来源期刊
Oncology Reviews
Oncology Reviews ONCOLOGY-
CiteScore
6.30
自引率
0.00%
发文量
9
审稿时长
9 weeks
期刊介绍: Oncology Reviews is a quarterly peer-reviewed, international journal that publishes authoritative state-of-the-art reviews on preclinical and clinical aspects of oncology. The journal will provide up-to-date information on the latest achievements in different fields of oncology for both practising clinicians and basic researchers. Oncology Reviews aims at being international in scope and readership, as reflected also by its Editorial Board, gathering the world leading experts in both pre-clinical research and everyday clinical practice. The journal is open for publication of supplements, monothematic issues and for publishing abstracts of scientific meetings; conditions can be obtained from the Editor-in-Chief or the publisher.
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