早期乳腺癌腋窝处理“降阶梯”策略:现状与进展  

"De-escalation"strategy in axillary management of early breast cancer:current status and progress

作　　者：邵新宇 彭帅 廖立秋[1,2,3] SHAO Xinyu;PENG Shuai;LIAO Liqu(Department of Breast Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Clinical Research Center for Breast Cancer,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Diseases(Xiangya Hospital),Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院乳腺外科,湖南长沙410008 [2]中南大学湘雅医院乳腺癌临床研究中心,湖南长沙410008 [3]中南大学湘雅医院国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008

出　　处：《中国普通外科杂志》2024年第11期1890-1896,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81974420);吴阶平医学基金会基金资助项目(320.6750.2023-18-84)。

摘　　要：早期乳腺癌腋窝淋巴结转移的评估对于疾病分期、辅助治疗决策、区域控制及预后判断至关重要,但腋窝处理的策略呈“降阶梯”趋势。临床腋窝淋巴结阴性(cN0)的早期乳腺癌,前哨淋巴结活检(SLNB)替代腋窝淋巴结清扫(ALND)成为腋窝淋巴结分期的标准术式,前哨淋巴结如为阴性,患者可免除ALND,在有效的全身治疗和区域放疗的加持下,前哨淋巴结低负荷转移可以免除ALND。部分cN0的早期乳腺癌患者可能可以豁免腋窝手术,但患者的选择需更精准。初始临床腋窝淋巴结阳性(cN1)的早期乳腺癌患者可以通过新辅助治疗转化为cN0后行SLNB豁免ALND,假阴性及安全性已有初步数据,但新辅助治疗后SLNB尚有诸多问题尚未解决,需要等待临床研究的结果。未来随着功能影像学、预测模型的兴起与应用,对早期乳腺癌的肿瘤学特征、转移负荷以及治疗反应等的评估将更为精准,早期乳腺癌腋窝处理将更为精准,“降阶梯”将更安全。The assessment of axillary lymph node metastasis in early-stage breast cancer is crucial for disease staging,adjuvant treatment decision-making,regional control,and prognosis estimation.However,the approach to axillary management has shown a"de-escalation"trend.For clinically node-negative(cN0)early-stage breast cancer,sentinel lymph node biopsy(SLNB)has replaced axillary lymph node dissection(ALND)as the standard procedure for axillary staging.If sentinel lymph nodes are negative,patients can forgo ALND.Even in cases of low-burden sentinel lymph node metastasis,ALND may be omitted with effective systemic therapy and regional radiotherapy.Some cN0 early-stage breast cancer patients may qualify to avoid axillary surgery altogether,but patient selection requires greater precision.For patients with clinically node-positive(cN1)early-stage breast cancer,neoadjuvant therapy can downstage them to cN0,allowing SLNB to replace ALND.Preliminary data on false negatives and safety are available,but many issues with SLNB post-neoadjuvant therapy remain unresolved,requiring further clinical research.In the future,with the advancement and application of functional imaging and predictive models,assessments of oncologic characteristics,metastatic burden,and treatment response in early-stage breast cancer will become more accurate.Axillary management for early-stage breast cancer will become more precise,and de-escalation will be safer.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 淋巴结清扫术 综述 

分 类 号：R737.9[医药卫生—肿瘤]