新辅助化疗与前哨淋巴结切除数量

　　最近的前瞻研究支持乳腺癌患者新辅助化疗后进行前哨淋巴结活检，如果至少三枚前哨淋巴结阳性，那么假阴性率较低。

　　2018年11月30日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表纽约纪念医院斯隆凯特林癌症中心的研究报告，探讨了新辅助化疗前腋窝淋巴结状态是否影响前哨淋巴结受累数量。

　　该研究通过纽约纪念医院斯隆凯特林癌症中心前瞻数据库，确定2014年5月～2016年4月接受新辅助化疗并且接受前哨淋巴结活检的I～III期乳腺癌患者343例，比较了临床淋巴结阴性和临床淋巴结阳性患者新辅助化疗后转为临床淋巴结阴性的临床和病理因素。通过广义线性混合模型，分析前哨淋巴结切除数量相关因素。

　　结果，新辅助化疗后前哨淋巴结活检确认前哨淋巴结阳性患者335例（98%），每例患者阳性前哨淋巴结数量1～14枚，中位4枚，与新辅助化疗前腋窝淋巴结状态无显著相关性（P=0.15）。总体而言，85%的患者至少三枚前哨淋巴结阳性，临床淋巴结阳性组显著高于临床淋巴结阴性组（89%比80%，P=0.02）。根据单因素分析，至少三枚前哨淋巴结阳性的显著相关因素包括：年龄<50岁并且淋巴结阳性。

　　因此，该研究结果表明，新辅助化疗后，98%的患者成功进行前哨淋巴结活检，手术失败极少。新辅助化疗后，阳性前哨淋巴结中位4枚，新辅助化疗前腋窝淋巴结状态对阳性前哨淋巴结数量无显著影响。

Ann Surg Oncol. 2018 Nov 30. [Epub ahead of print]

Does Lymph Node Status Prior to Neoadjuvant Chemotherapy Influence the Number of Sentinel Nodes Removed?

Jennifer L. Baker, Shirin Muhsen, Emily C. Zabor, Michelle Stempel, Mary L. Gemignani.

Memorial Sloan Kettering Cancer Center, New York. USA.

BACKGROUND/OBJECTIVE: Recent prospective trials support the use of sentinel lymph node biopsy (SLNB) in breast cancer patients after neoadjuvant chemotherapy (NAC) with a lower false-negative rate if three or more sentinel lymph nodes (SLNs) are identified. In this study, we investigated whether the pre-NAC axillary lymph node status influences the number of SLNs identified.

METHODS: Stage I-III breast cancer patients who received NAC and underwent SLNB from May 2014 to April 2016 were identified from an institutional prospective database. Clinical and pathological factors among clinically node-negative (cN-) and clinically node-positive (cN+) patients who converted to cN-post-NAC were compared. Generalized linear mixed models analyzed factors associated with the number of SLNs removed.

RESULTS: Among 343 patients who underwent SLNB during the study period, 335 (98%) had at least one SLN identified, and subsequently comprised the study population. The median number of SLNs identified was 4 (range 1-14), which did not differ according to pre-NAC nodal status (P=0.15). Overall, 85% of patients had three or more SLNs identified (80% cN-group vs. 89% cN+group; P=0.02). On univariable analysis, age<50 years and presenting with a positive axillary node were significantly associated with identifying three or more SLNs.

CONCLUSIONS: Our study confirms that SLNB was successfully performed in 98% of our patients after NAC, with very few failed mapping procedures. In the post-NAC setting, the median number of SLNs identified was four, and the status of the axilla prior to NAC did not negatively affect the number of SLNs identified.

DOI: 10.1245/s10434-018-7004-6