新辅助化疗对乳腺癌腋窝前哨淋巴结和非前哨淋巴结的影响  

Effect of neoadjuvant chemotherapy on axillary sentinel lymph nodes and non-sentinel lymph nodes in breast cancer

作　　者：张炯 郑婷[2] 郭千红 车康明 王娜 马舟 Zhang Jiong;Zheng Ting;Guo Qian-hong;Che Kang-ming;Wang Na;Ma Zhou(The First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Tumor Surgery,The First People's Hospital of Tianshui,Tianshui 741000,Gansu,China)

机构地区：[1]甘肃省中医药大学第一临床医学院,甘肃兰州730000 [2]天水市第一人民医院肿瘤外科,甘肃天水741000

出　　处：《兰州大学学报（医学版）》2022年第9期47-50,共4页Journal of Lanzhou University（Medical Sciences）

基　　金：国家自然科学基金资助项目(61861040);甘肃省科学技术计划资助项目(17YF1FA119);天水市科技支撑计划资助项目(2021-SHFZK-5231)。

摘　　要：目的探讨乳腺癌新辅助化疗(NAC)对前哨淋巴结(SLN)与非前哨淋巴结(NSLN)的影响及前哨淋巴结活检(SLNB)的可行性。方法对2019年1月-2021年12月在天水市第一人民医院治疗的155例原发性乳腺癌患者进行6周期NAC,选取NAC后临床检查腋窝淋巴结无肿大的患者25例,行腋窝SLNB后再行改良根治术,分析原发肿瘤、腋窝淋巴结变化、雌激素受体(ER)、细胞增殖相关抗原(Ki-67)表达及淋巴结转移情况。结果25例患者中SLN转移9例,原发肿瘤缩小率、MP分级、Ki-67表达情况均与SLN转移相关(P<0.05);SLN转移和ER表达情况不相关(P=0.229)。NSLN转移与化疗及肿瘤分子特征不相关。结论临床评价腋窝淋巴结阴性(cN0)患者NAC后行SLNB安全,cN1患者NAC后行SLNB需谨慎,NAC对淋巴结跳跃式转移作用有限,对于ER和Ki-67同时高表达、化疗疗效差的患者全腋窝清扫是最佳方法。Objective To investigate the effect of neoadjuvant chemotherapy(NAC)for breast cancer on sentinel lymph nodes(SLN)and non-sentinel lymph nodes(NSLN)and the feasibility of sentinel lymph node biopsy(SLNB).Methods A total of 155 patients with primary breast cancer,who were treated in The First People's Hospital of Tianshui from January,2019 to December,2021,were selected for 6 cycles of NAC,and 25 patients without axillary lymph node enlargement were selected for axillary SLNB followed by modified radical mastectomy.The primary tumor,axillary lymph node changes,estrogen receptor(ER),cell proliferation,associated antigen(Ki-67)expression and lymph node metastasis were analyzed.Results There were 9 cases of SLN metastasis in 25 patients.The primary tumor shrinkage rate,MP grade and Ki-67 expression were all correlated with SLN metastasis(P<0.05).SLN metastasis was not correlated with ER expression(P=0.229).NSLN metastasis was not associated with chemotherapy or tumor molecular characteristics.Conclusion SLNB after NAC is safe in patients with negative lymph nodes(cN0),while SLNB after NAC in patients with cN1 should be cautiously done.NAC has a limited effect on lymph node skip metastasis.Total axillary dissection is the best method for patients with a high expression of ER and Ki-67 and poor chemotherapy response.

关 键 词：乳腺癌 新辅助化疗 前哨淋巴结活检 腋窝淋巴结清扫 

分 类 号：R737.9[医药卫生—肿瘤]