乳腺癌新辅助治疗后内乳前哨淋巴结活检的预后意义

Prognostic significance of internal mammary sentinel lymph node biopsy after neoadjuvant therapy in breast cancer

    摘要
  • 摘要:
    目的 本研究旨在评估早期乳腺癌患者新辅助治疗（neoadjuvant therapy，NAT）后接受内乳前哨淋巴结活检（internal mammary sentinel lymph node biopsy，IM-SLNB）的准确性，同时探索IM-SLNB在指导分期、评估预后和优化辅助治疗策略上的优势。
    方法 回顾性收集2013年10月至2023年11月于山东省肿瘤医院经NAT后行IM-SLNB的132例女性患者的临床数据。分析患者临床病理特征对内乳淋巴结（internal mammary lymph node，IMLN）转移的影响。同时评估NAT后IMLN转移状态对患者预后的影响。
    结果 本研究最终纳入132例接受NAT后IM-SLNB乳腺癌患者，腋窝淋巴结（axillary lymph node， ALN）和IMLN总体转移率分别为 90.9%（120/132）和9.1%（12/132），ALN阳性/ IMLN阳性组、ALN阳性/IMLN阴性组、ALN 阴性/IMLN阳性组和ALN阴性/IMLN阴性组患者比例分别为8.3%（11/132）、43.1%（57/132）、0.7%（1/132）、47.7%（63/132）。NAT后内乳前哨淋巴结的检出率为98.5% （132/134），其中2例患者因手术困难未行IM-SLNB。12例IMLN转移患者中6例患者术后病理分期发生了改变（2例由ⅢA期→ⅢC期，2例由ⅡB期→ⅢC期，1例由ⅡA期→ⅢA期，1例由ⅡA期→ⅢC期）。IMLN转移状况是无病生存期（disease-free survival，DFS）及总生存期（overall survival， OS）的独立危险因素（均P<0.05），和IMLN阴性患者相比，IMLN阳性患者DFS及OS均显著降低（均P<0.05）。
    结论 NAT后淋巴结病理状态应同时考虑ALN和IMLN的病理状态。NAT后IMLN有术中显像患者应接受IM-SLNB，以期获得完整的淋巴结分期。NAT后IMLN转移状况是独立预后因素。

     

    Abstract:
    Objective  This study evaluated the accuracy of internal mammary sentinel lymph node biopsy (IM-SLNB) in patients with early-stage breast cancer after receiving neoadjuvant therapy (NAT). It explored the benefits of IM-SLNB in guiding cancer staging, evaluating prognosis, and optimizing adjuvant treatment strategies.
    Methods A retrospective study was conducted to collect clinical data of patients who received IM-SLNB following NAT in Shandong Cancer Hospital and Institute from October 2013 to November 2023. We analyzed the influence of clinicopathological characteristics on internal mammary lymph node (IMLN) metastasis and assessed the prognostic significance of IMLN metastasis following NAT.
    Results The study included 132 breast cancer patients who underwent IM-SLNB following NAT. The metastasis rates of axillary lymph nodes (ALN) and internal mammary lymph nodes (IMLN) were 90.9% (120/132) and 9.1% (12/132), respectively. The percentages of patients in the following groups were as follows: ALN-positive/IMLN-positive (8.3%, 11/132), ALN-positive/IMLN-negative (43.1%, 57/132), ALN-negative/IMLN-positive (0.7%, 1/132), and ALN-negative/IMLN-negative (47.7%, 63/132). The detection rate of internal mammary sentinel lymph nodes (IM-SLN) after NAT was 98.5% (132/134); two patients could not undergo IM-SLNB owing to surgical difficulties. Among the 12 cases of IMLN metastasis, 6 patients experienced a change in postoperative pathological staging: 2 shifted from stage ⅢA to ⅢC, 2 from stage ⅡB to ⅢC, 1 from stage ⅡA to ⅢA, and 1 from stage ⅡA to ⅢC. IMLN metastasis was determined to be an independent risk factor for disease-free survival (DFS) and overall survival (OS) (P<0.05). Patients with IMLN metastasis demonstrated significantly lower DFS and OS than those without IMLN metastasis (P<0.05).
    Conclusions The pathological status of both ALN and IMLN should be considered in the axillary pathological response after NAT. Patients with detectable IMLN during surgery after NAT should undergo IM-SLNB to ensure comprehensive lymph node staging. The status of IMLN metastasis following NAT serves as an independent prognostic factor.

     

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