摘要
目的探讨我国1~2枚前哨淋巴结(SLN)阳性乳腺癌患者避免腋窝淋巴结清扫(ALND)的可行性。方法回顾性收集2010–2016年间于笔者所在医院院行前哨淋巴结活检(SLNB)的328例患者,将符合Z0011试验结果(未接受新辅助治疗,临床肿瘤分期为T1/T2期,SLN阳性数目为1~2枚,行保乳手术、术后接受全乳放疗和全身辅助治疗)的病例设定为保乳组;将除手术方式之外,其余均满足Z0011试验结果的病例设为非保乳组,将保乳组和非保乳组患者的临床病理学特征与Z0011 ALND组进行比较。结果 328例患者中,仅29例(8.8%)完全符合Z0011试验结果。保乳组和Z0011 ALND组患者的年龄、肿瘤T分期、雌激素受体(ER)表达、孕激素受体(PR)表达、病理学类型、组织学分级、阳性淋巴结数量和非前哨淋巴结(NSN)转移情况比较差异均无统计学意义(P>0.05)。81例患者归入非保乳组,非保乳组和Z0011 ALND组患者的ER表达、PR表达及组织学分级比较差异均无统计学意义(P>0.05),但2组患者的年龄、肿瘤T分期、病理学类型、阳性淋巴结数量及NSN转移情况比较差异均有统计学意义(P<0.05),非保乳组患者的年龄较小,T2期比例较高,小叶癌比例高、导管癌比例低,阳性淋巴结多,NSN转移率高。结论 Z0011试验结果可用于我国的临床实践,但根据我国的实际保乳情况可能导致受适人群比例偏低。
Objective To explore the feasibility of breast cancer patients in China with 1-2 positive sentinel lymph nodes （SLN） to avoid axillary lymph node dissection （ALND）. Methods A total of 328 patients who received sentinel lymph node biopsy （SLNB） in our hospital from 2010 to 2016 were collected retrospectively, and patients met the criteria of Z0011 clinical trials （which required no acceptance of neoadjuvant therapy, clinical tumor size was in T1/T2 stage, two or less positive SLNs were detected, received breast-conservation surgery, acceptance of whole breast radiotherapy after surgery and neoadjuvant systemic treatment） were enrolled to breast-conservation group. Patients met the criteria of Z0011 clinical trials, excepting the surgery （received non-breast-conservation surgery）, were enrolled to non- breast-conservation group. Comparison of clinicopathological features between the breast-conservation group/non- breast-conservation group and the Z0011 ALND group was performed. Results Among the 328 patients, only 29 patients （8.8%） completely correspond with the results of Z0011 clinical trials. There was no statistical significance between the breast-conservation group and the ZOO 11 ALND group in the age, clinical T stage, expression of estrogen （ER）, expression of progesterone （PR）, pathological type, histological grade, number of positive lymph nodes, and incidence of non-sentinel node metastasis （P〉0.05）. A total of 81 patients were included in the non-breast-conservation group. It showed no statistical significance between the non-breast-conservation group and the Z0011 ALND group in expressions of ER and PR, and histological grade （P〉0.05）, while there was statistically significant difference in age, clinical T stage, pathological type,number of positive lymph nodes, and incidence of non-sentinel node metastasis （P〈0.05）. Patients in the non-breast-conservation group showed a lower age, higher percentage of lobular carcinoma and T2 stage, more positive lymph nodes, and high incidence of non-sentinel node metastasis. Conclusion It＇s feasible for Z0011 clinical trials results to be used in the clinical practice of our country, but the actual situation of breast conservation in our country may lead to low adaptive population.
出处
《中国普外基础与临床杂志》
CAS
2017年第9期1085-1089,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
乳腺癌
前哨淋巴结
腋窝淋巴结清扫
Z0011试验
breast cancer
sentinel lymph node
axillary lymph node dissection
Z0011 clinical trials
