前哨淋巴结时代乳腺癌的精准区域处理：演进与展望

doi:10.19401/j.cnki.1007-3639.2022.08.002

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (8): 680-687.doi: 10.19401/j.cnki.1007-3639.2022.08.002

前哨淋巴结时代乳腺癌的精准区域处理：演进与展望

邱鹏飞()(), 王永胜()()

山东省肿瘤防治研究院（山东省肿瘤医院）,山东第一医科大学（山东省医学科学院）,山东济南 250117

收稿日期:2022-06-10 修回日期:2022-07-15 出版日期:2022-08-30 发布日期:2022-09-19
通信作者: 王永胜 E-mail:qiupengfei2002@126.com;wangysh2008@aliyun.com
作者简介:邱鹏飞（ORCID: 0000-0001-6784-410X）,主任医师,山东省肿瘤医院乳腺外科副主任,E-mail: qiupengfei2002@126.com。
王永胜,二级教授、博士研究生导师,山东省肿瘤医院乳腺病中心主任。现任中国抗癌协会乳腺癌专业委员会副主任委员,中国抗癌协会国际医疗交流分会副主任委员,中国临床肿瘤学会乳腺癌专家委员会常务委员,中国医师协会肿瘤分会乳腺癌学组副组长,中华医学会肿瘤学分会乳腺癌学组委员,国家卫健委乳腺癌诊疗规范专家组成员,全球乳腺癌大会国际指导专家委员会成员,山东省抗癌协会靶向治疗分会主任委员。于国内率先开展乳腺癌保留乳房手术、前哨淋巴结活检替代腋窝淋巴结清扫术、乳腺病变微创诊断等研究,作为组长单位和首席专家,牵头开展了中国临床早期乳腺癌前哨淋巴结活检替代腋窝清扫术的多中心研究、乳腺癌内乳区前哨淋巴结活检术的多中心前瞻性临床验证研究和新型示踪技术引导乳腺癌内乳前哨淋巴结活检的多中心前瞻性临床研究,研究成果已达到国际领先水平,并参与多项国际和国内乳腺癌Ⅲ期临床研究。以第一作者或通信作者发表论文100余篇,其中在SCI收录期刊上发表论文30余篇,出版专著（译著等）共4部,授权国家发明专利2项,获奖成果共5项,其中国家级1项、部（省）级4项,作为主要负责人承担国家级项目4项、部（省）级项目3项。
基金资助:
国家自然科学基金(82172873);山东省自然科学基金(ZR2021QH002);中国博士后科学基金(2021M691334)

Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect

QIU Pengfei()(), WANG Yongsheng()()

Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China

Received:2022-06-10 Revised:2022-07-15 Published:2022-08-30 Online:2022-09-19
Contact: WANG Yongsheng E-mail:qiupengfei2002@126.com;wangysh2008@aliyun.com

摘要/Abstract

摘要：

区域淋巴结状况是乳腺癌重要的预后指标之一,可以指导分期和辅助治疗策略的制定。近30年来乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）研究发展迅速,循证医学Ⅰ类证据支持其为临床腋窝淋巴结阴性早期乳腺癌患者安全、有效的腋窝分期技术,前哨淋巴结阴性及低肿瘤负荷患者SLNB替代腋窝淋巴结清扫术后腋窝复发风险和并发症极低。乳腺癌局部区域控制新理念——应该综合考虑远处转移风险、全身治疗效果与不良反应以及局部区域治疗（手术/放疗）效果与不良反应——推动了SLNB适应人群不断扩展,新辅助治疗与SLNB、内乳SLNB将进一步促进区域淋巴结处理降阶梯,豁免腋窝手术临床研究值得期待。SLNB标志着乳腺癌区域淋巴结迈入微创化精准诊疗时代。本文就前哨淋巴结时代乳腺癌的精准区域处理的演进过程和最新进展进行总结,以期为广大临床工作者提供参考。

关键词: 乳腺癌, 前哨淋巴结活检, 腋窝淋巴结, 内乳淋巴结

Abstract:

Regional lymph node status is one of the important prognostic indicators of breast cancer, which can guide the staging and adjuvant treatment strategy. Sentinel lymph node biopsy (SLNB) for breast cancer has developed rapidly over the past three decades, evidence-based medicine class Ⅰ evidence supports that SLNB is a safe and effective axillary staging technique for patients with clinically negative axillary lymph node in early breast cancer. The risk of axillary recurrence and complications in breast cancer patients with negative/few-positive sentinel lymph node omitting axillary lymph node dissection is very low. Locoregional management of breast cancer should consider the metastatic risk of the primary tumor, the efficacy and side effects of systemic therapy, and the efficacy and side effects of locoregional therapy (surgery/radiotherapy). This view has promoted the continuous expansion of the SLNB population. SLNB with neoadjuvant therapy and internal mammary SLNB will further promote the de-escalation therapy, and the ongoing studies of omission of axillary surgery should be anticipated. The era of precision medicine for regional lymph node management of breast cancer has gradually arrived with the development of SLNB. This article evaluated the latest progress of precise regional processing of breast cancer in the sentinel lymph node era, in order to provide reference for clinical doctors.

Key words: Breast cancer, Sentinel lymph node biopsy, Axillary lymph node, Internal mammary lymph node

中图分类号:

R737.9

邱鹏飞, 王永胜. 前哨淋巴结时代乳腺癌的精准区域处理：演进与展望[J]. 中国癌症杂志, 2022, 32(8): 680-687.

QIU Pengfei, WANG Yongsheng. Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect[J]. China Oncology, 2022, 32(8): 680-687.

图/表 1

参考文献 42

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Item	French (n=1 334)	EORTC 22922/10925 (n=4 004)	MA.20 (n=1 832)	DBCG-IMN (n=3 089)
Recruitment years	1991-1997	1996-2004	2000-2007	2003-2007
Follow-up years (median)	11.3	15.7	9.5	14.8
Proportion of positive axillary node	75.2%	55.5%	90.3%	100.0%
Proportion of adjuvant systemic therapy	Chemotherapy 60.9% Endocrine therapy 52.3%	84.4%	100.0%	100.0%
Breast cancer recurrence	43.1% vs 50.3%	24.5% vs 27.1% ^Δ	NA	NA
Breast cancer mortality	NA	16.0% vs 19.8% ^Δ	10.3% vs 12.3%	31.7% vs 33.9%^Δ
Distant disease-free survival	NA	70.0% vs 68.2%	86.3% vs 82.4%^Δ	64.4% vs 61.4%^Δ
DFS	53.2% vs 49.9%	60.8% vs 59.9%	82.0% vs 77.0%^Δ	NA
OS	62.6% vs 59.3%	73.1% vs 70.9%	82.8% vs 81.8%	60.1% vs 55.4%^Δ

前哨淋巴结时代乳腺癌的精准区域处理：演进与展望

Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect

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