乳腺癌新辅助治疗后前哨淋巴结阴性患者豁免腋窝淋巴结清扫的可行性研究  

Feasibility study of exempting axillary lymph node dissection in patients with sentinel lymph node negative after neoadjuvant therapy for breast cancer

作　　者：肖顺崇 覃俊仕[1] 张艳珍 张燕侨 XIAO Shunchong;QIN Junshi;ZHANG Yanzhen;ZHANG Yanqiao(Guigang City People's Hospital,Guigang 537100;Guangxi Zhuang Autonomous Region Institute of Cancer Prevention and Treatment,Nanning 530021,China)

机构地区：[1]贵港市人民医院,广西贵港537100 [2]广西壮族自治区肿瘤防治研究所,广西南宁530021

出　　处：《临床医学研究与实践》2025年第7期49-52,共4页Clinical Research and Practice

基　　金：广西壮族自治区中医药管理局自筹经费科研课题(No.GXZYZ20210201);贵港市自筹经费科研项目(贵科攻2100030)。

摘　　要：目的探讨乳腺癌新辅助治疗后前哨淋巴结阴性患者是否可豁免同侧腋窝淋巴结清扫(ALND)。方法回顾性分析2020年1月至2024年6月贵港市人民医院收治的60例新辅助治疗后行前哨淋巴结活检并成功检出前哨淋巴结的乳腺癌患者资料。所有患者完成足疗程新辅助治疗后进行前哨淋巴结活检,再行乳腺癌根治性切除术及ALND。收集入组患者的临床病理资料,分析前哨淋巴结活检阴性患者的病理完全缓解(pCR)、ALND情况及与临床病理资料的相关性。结果60例患者共检出前哨淋巴结230枚,平均每例患者检出3.83枚。前哨淋巴结活检阳性23例,阴性37例。37例前哨淋巴结活检阴性患者中,33例ALND阴性,4例ALND阳性。达到pCR前哨淋巴结活检阴性患者的ALND阳性率低于未达到pCR前哨淋巴结活检阴性患者(P<0.05)。人表皮生长因子受体-2(HER-2)阳性及前哨淋巴结检出数量≥3枚前哨淋巴结活检阴性患者的ALND阳性率低于HER-2阴性及前哨淋巴结检出数量<3枚前哨淋巴结活检阴性患者(P<0.05)。结论乳腺癌新辅助治疗后前哨淋巴结阴性患者若治疗效果达到pCR、HER-2为阳性及前哨淋巴结检出数量≥3枚时,有望豁免ALND。Objective To investigate whether ipsilateral axillary lymph node dissection(ALND)can be exempted in patients with sentinel lymph node negative after neoadjuvant therapy for breast cancer.Methods The data of 60 breast cancer patients who underwent sentinel lymph node biopsy after neoadjuvant therapy and successfully detected sentinel lymph nodes in Guigang City People's Hospital from January 2020 to June 2024 were retrospectively analyzed.All patients underwent sentinel lymph node biopsy after full course of neoadjuvant therapy,and then underwent radical mastectomy and ALND.The clinicopathological data of the enrolled patients were collected,and the pathological complete response(pCR),ALND and the correlation between and clinicopathological data were analyzed.Results A total of 230 sentinel lymph nodes were detected in 60 patients,with an average of 3.83 per patient.Sentinel lymph node biopsy was positive in 23 cases and negative in 37 cases.Among the 37 patients with negative sentinel lymph node biopsy,33 cases were ALND negative and 4 cases were ALND positive.The positive rate of ALND in the patients with negative sentinel lymph node biopsy of reaching pCR was lower than that in patients with negative sentinel lymph node biopsy of without reaching pCR(P<0.05).The positive rate of ALND in patients with negative sentinel lymph node biopsy of positive human epidermal growth factor receptor-2(HER-2)and negative sentinel lymph node biopsy≥3 was lower than that in patients with negative sentinel lymph node biopsy of negative HER-2 and negative sentinel lymph node biopsy<3(P<0.05).Conclusion ALND is expected to be exempted in patients with sentinel lymph node negative after neoadjuvant therapy for breast cancer if the treatment effect reaches pCR,HER-2 is positive and the number of sentinel lymph nodes detected is≥3.

关 键 词：乳腺癌 前哨淋巴结活检 腋窝淋巴结清扫 新辅助治疗 

分 类 号：R737.9[医药卫生—肿瘤]