接受新辅助化疗的乳腺癌患者腋窝淋巴结清扫标本的低淋巴结率:质量问题还是治疗效果?

IF 1.9 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Breast Journal Pub Date : 2021-12-08 DOI:10.1111/tbj.14303
Junko Ozao-Choy MD, FACS, Ashkan Moazzez MD, MPH, FACS, Christine Dauphine MD, FACS
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引用次数: 2

摘要

腋窝淋巴结清扫(ALND)标本应至少有十个淋巴结检查根据既定的指导方针。尽管如此,最近的证据表明,新辅助化疗(NAC)可减少标本中的淋巴结。我们试图研究NAC患者在ALND标本中是否有较低的淋巴结产量,以及标本中淋巴结的数量是否与病理完全缓解(pCR)相关。使用国家癌症数据库(NCDB),确定了2012年至2015年诊断为淋巴结阳性,非转移性浸润性乳腺癌的女性患者的研究队列。比较NAC和非NAC患者腋窝淋巴结恢复计数,并与pCR进行相关分析。进行多变量分析以确定与ALND病理标本中少于10个淋巴结相关的因素。在确定的56,976例患者中,27,197例(48%)接受了新辅助化疗;29779例(52%)没有。NAC患者在ALND标本中未能达到10个淋巴结最小值的比例高于非NAC患者(35% vs. 27%, p <0.001)。小于10个淋巴结的NAC患者比大于或等于10个淋巴结的NAC患者更容易出现pCR (22% vs. 16%, p <0.001)。在多变量分析中,发现原发肿瘤的pCR和受体状态是ALND标本中淋巴结少于10个的独立预测因子。接受NAC的淋巴结阳性乳腺癌患者更有可能不符合10个淋巴结的标准。然而,与达到最低要求的NAC患者相比,未达到最低要求的NAC患者也更有可能出现pCR。这表明较低的淋巴结产量可能不是手术质量较差的标志,而是NAC治疗效果的潜在标志。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lower lymph node yield in axillary lymph node dissection specimens in breast cancer patients receiving neoadjuvant chemotherapy: Quality concern or treatment effect?

Axillary lymph node dissection (ALND) specimens should have at least ten-lymph nodes for examination according to established guidelines. Nonetheless, recent evidence suggests that neoadjuvant chemotherapy (NAC) results in fewer nodes in the specimen. We sought to examine if NAC patients have lower lymph node yield from ALND specimens and whether the number of lymph nodes in the specimen is correlated with pathologic complete response (pCR). Using the National Cancer Database (NCDB), a study cohort of female patients with node-positive, non-metastatic invasive breast cancer diagnosed from 2012 to 2015 was identified. The axillary lymph node retrieval count was compared in NAC and non-NAC patients and then correlated with pCR. A multivariable analysis was performed to identify factors that were associated with less than ten-lymph nodes in the ALND pathologic specimen. Of 56,976 patients identified, 27,197 (48%) received neoadjuvant chemotherapy; 29,779 (52%) did not. NAC patients failed to meet the ten-lymph node minimum in the ALND specimen more often than non-NAC patients (35% vs. 27%, < 0.001). NAC patients with fewer than ten-lymph nodes were more likely to have a pCR than those with ten or more (22% vs. 16%, < 0.001). On multivariable analysis, pCR of the primary tumor and receptor status were found to be independent predictors of having fewer than ten-lymph nodes in the ALND specimen. Node-positive breast cancer patients that underwent NAC were more likely to not meet the ten-lymph node standard. However, NAC patients who did not meet the minimum were also more likely to have a pCR compared to NAC patients who did. This suggests lower lymph node yield may not truly be a marker of lower quality surgery but rather a potential marker of NAC treatment effect.

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来源期刊
Breast Journal
Breast Journal 医学-妇产科学
CiteScore
4.00
自引率
0.00%
发文量
47
审稿时长
4-8 weeks
期刊介绍: The Breast Journal is the first comprehensive, multidisciplinary source devoted exclusively to all facets of research, diagnosis, and treatment of breast disease. The Breast Journal encompasses the latest news and technologies from the many medical specialties concerned with breast disease care in order to address the disease within the context of an integrated breast health care. This editorial philosophy recognizes the special social, sexual, and psychological considerations that distinguish cancer, and breast cancer in particular, from other serious diseases. Topics specifically within the scope of The Breast Journal include: Risk Factors Prevention Early Detection Diagnosis and Therapy Psychological Issues Quality of Life Biology of Breast Cancer.
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