乳腺癌术后孤立腋窝淋巴结复发的临床特征与治疗进展

doi:10.19401/j.cnki.1007-3639.2025.06.009

摘要/Abstract

摘要：

乳腺癌术后孤立腋窝淋巴结复发（axillary recurrence，AR）是影响患者预后的关键因素之一。随着诊疗技术的进步，临床对AR的认识逐渐加深，但由于AR发生率较低，目前关于其临床特征的系统性研究仍然有限。ACOSOG Z0011、AMAROS等高质量临床研究证实，在不同前哨淋巴结状态的患者中，腋窝淋巴结清扫（axillary lymph node dissection，ALND）与前哨淋巴结切除（sentinel lymph node dissection，SLND）在AR控制方面的效果均相当。近年来，腋窝手术去侵袭化的趋势推进了靶向腋窝淋巴结清扫等低创伤手段的诞生。SOUND试验进一步表明，对于肿瘤直径≤2 cm的患者，豁免腋窝手术是安全且可行的。一系列临床研究已识别出了多种潜在的高危因素，包括患者年龄、阳性淋巴结数量、Ki-67增殖指数高、淋巴结外侵犯以及腋窝软组织浸润，然而这些因素与AR的关系并不完全清楚。本综述全面梳理AR的临床特征、高危因素及个体化管理策略，重点探讨不同腋窝手术方式、放疗与系统治疗对AR风险的影响。此外，未来亟待开展更多高质量临床研究，进一步明确AR的预后因素，优化个体化治疗方案，从而为AR患者提供更精准的管理策略。

关键词: 乳腺癌, 区域淋巴结复发, 乳腺癌预后

Abstract:

Isolated axillary recurrence (AR) after breast cancer surgery is one of the critical factors influencing patients’ prognosis. With advancements in diagnostic and therapeutic techniques, the clinical understanding of AR has progressively deepened. However, due to the low incidence of AR, systematic studies on its clinical features remain limited. High-quality clinical trials, such as ACOSOG Z0011 and AMAROS, have demonstrated that in patients with varying statuses of sentinel lymph node, axillary lymph node dissection (ALND) and sentinel lymph node dissection (SLND) provide comparable control of AR. In recent years, the trend towards de-escalation axillary surgery has advanced the development of less invasive techniques such as targeted axillary lymph node dissection. The SOUND trial further confirmed the safety and feasibility of omitting axillary surgery in patients with tumors ≤2 cm. In addition, a series of clinical studies have identified a variety of potential high-risk factors, including patient age, number of positive lymph nodes, high Ki-67 proliferation, extranodal extension, and axillary soft tissue infiltration. However, there is no broad consensus regarding the association of these factors with AR. This review comprehensively summarized the clinical characteristics, risk factors and personalized management strategies of AR, with an emphasis on the impact of different axillary surgical approaches, radiotherapy and systemic therapy on the AR risk. In addition, more high-quality clinical studies are urgently needed to further clarify prognostic factors and optimize individualized treatment strategies, so as to provide more precise management for patients.

Key words: Breast cancer, Regional lymph node recurrence, Breast cancer prognosis

中图分类号:

R737.9

杜心悦, 邬思雨, 柳光宇. 乳腺癌术后孤立腋窝淋巴结复发的临床特征与治疗进展[J]. 中国癌症杂志, 2025, 35(6): 592-600.

DU Xinyue, WU Siyu, LIU Guangyu. Clinical characteristics and treatment advances in isolated axillary lymph node recurrence after breast cancer surgery[J]. China Oncology, 2025, 35(6): 592-600.

图/表 1

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Clinical scenario	Reference	Year	Research type	No. of patients	Tumor stage	Follow-up t/month	AR incidence/%
SLN(-)+SLND	Van der Ploeg I M, et al.^[15]	2008	Systemic review	14 959	T1-3	34	0.3
	Van Wely B J, et al.^[16]	2012	Prospective study	929	T1-3	77	1.6
	Ogiya A, et al.^[19]	2016	Prospective study	2 578	T1-3	75	0.9
	Veronesi U, et al.^[17]	2006	Randomized controlled trial	167	T1	79	0.6
	Krag D N, et al.^[18]	2010	Randomized controlled trial	2 011	T1-3	95.6	0.4
ALND	Giuliano A E, et al.^[29]	2017	Randomized controlled trial	420	T1-2	111.6	0.5
	Bilimoria K Y, et al.^[8]	2009	Prospective study	77 097	T1-3	63	1.2
	Houvenaeghel G, et al.^[10]	2016	Retrospective study	1 671	T1-3	60.4	0.6
	Bartels S A L, et al.^[32]	2023	Randomized controlled trial	744	T1-2	120	0.9
SLN(+)+SLND	Giuliano A.E. et al.^[28-29]	2017	Randomized controlled trial	436	T1-2	75.6	0.9
						111.6	1.5
	Tvedskov T F, et al.^[9]	2015	Prospective study	240	T1-3	75	1.6
	Houvenaeghel G, et al.^[10]	2016	Retrospective study	338	T1-3	60.4	1.2
	Bilimoria K Y, et al.^[8]	2009	Prospective study	20 217	T1-3	63	1.0