Long-Term Survival of Node-Positive Breast Cancer with Complete Nodal Response to Neoadjuvant Chemotherapy Treated with Sentinel Lymph Node Biopsy Alone: A Meta-Analysis.

IF 1.8 3区医学 Q3 ONCOLOGY

Oncology Pub Date : 2025-02-03 DOI:10.1159/000543662

Yunfeng Ding, Wanbo Wu, Xiaofeng Ni, Zhanwei Wang

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引用次数: 0

Abstract

Introduction: There exist concerns regarding the use of sentinel lymph node (SLN) biopsy alone in node-positive breast cancer patients who have a clinical/radiological complete response in the axilla and are negative on histopathology after neoadjuvant chemotherapy (NACT). We hereby conducted a meta-analysis examining 5-year overall survival (OS) and disease-free survival (DFS) of such patients.

Methods: PubMed, the Cochrane CENTRAL Library, Embase, Web of Science, and Scopus were searched up to July 30, 2024, for studies reporting survival data. OS and DFS were pooled in a meta-analysis. Subgroup analysis was conducted based on the location of the study, pre-NACT node assessment, and SLN mapping technique. Random-effects meta-regression was conducted for the following moderators: age, initial T3-4, initial N2-3, breast-conserving surgery, breast pathological complete response (pCR), number of SLN removed, adjuvant radiotherapy, endocrine therapy, and follow-up.

Results: Sixteen studies with 5,249 patients were included. Meta-analysis showed that node-positive breast cancer patients showing nodal pCR after NACT and undergoing only SLN biopsy had a 5-year OS and DFS of 94% (95% CI: 92%, 96%) and 89% (95% CI: 87%, 92%), respectively. There was not much variation in the survival rate on sensitivity and subgroup analyses. Meta-regression showed that OS and DFS were higher in studies with a greater number of patients receiving endocrine therapy.

Conclusion: Breast cancer patients with cN+ who achieve a complete clinical/radiological axillary response after NACT and subsequently become SLN biopsy negative may have high rates of DFS and OS after 5 years. Given the high degree of heterogeneity, results should be interpreted with caution. We do not recommend change in treatment plans given the high risk of bias and large heterogeneity in the patient population included in the studies. Only high-quality large multicentric randomized trials can provide better evidence.

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单纯前哨淋巴结活检治疗对新辅助化疗有完全淋巴结反应的淋巴结阳性乳腺癌的长期生存率：一项荟萃分析。

导论：对于腋部临床/放射学完全缓解且新辅助化疗（NACT）后组织病理学阴性的淋巴结阳性乳腺癌患者单独使用前哨淋巴结（SLN）活检存在担忧。因此，我们对这类患者的5年总生存期（OS）和无病生存期（DFS）进行了荟萃分析。方法：检索PubMed、Cochrane CENTRAL library、Embase、Web of Science和Scopus，检索截止到2024年7月30日报告生存数据的研究。OS和DFS合并进行meta分析。根据研究地点、nact前淋巴结评估和SLN制图技术进行亚组分析。对以下调节因素进行随机效应meta回归：年龄、初始T3-4、初始N2-3、保乳手术、乳腺病理完全缓解（pCR）、SLN切除数、辅助放疗、内分泌治疗和随访。结果：纳入16项研究，5249例患者。荟萃分析显示，淋巴结阳性乳腺癌患者在NACT后出现淋巴结pCR，仅接受SLN活检，其5年OS和DFS分别为94% （95% CI: 92%, 96%）和89% （95% CI: 87%, 92%）。在敏感性和亚组分析中，生存率没有太大变化。meta回归显示，接受内分泌治疗的患者越多，OS和DFS越高。结论：cN+乳腺癌患者在NACT后达到完全的临床/放射学腋窝反应，随后变为SLN活检阴性，5年后DFS和OS的发生率可能很高。考虑到高度的异质性，结果应谨慎解释。鉴于纳入研究的患者群体存在高偏倚风险和较大异质性，我们不建议改变治疗方案。只有高质量的大型多中心随机试验才能提供更好的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.