临床淋巴结阴性乳腺癌新辅助化疗与腋窝降阶梯处理的研究

石志强; 邱鹏飞; 丛斌斌

doi:10.19401/j.cnki.1007-3639.2018.12.007

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临床淋巴结阴性乳腺癌新辅助化疗与腋窝降阶梯处理的研究

更新时间：2026-01-27

- 临床淋巴结阴性乳腺癌新辅助化疗与腋窝降阶梯处理的研究
- Neoadjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer
- 中国癌症杂志 2018年28卷第12期页码：922-927
- 作者机构：
  
  1. 山东大学齐鲁医学院,山东,济南,250012
  2. 山东大学附属山东省肿瘤医院乳腺病中心外科三病区,山东,济南,250117
- 作者简介：
- 基金信息：
  
  国家自然科学基金（81502314）;山东省医药卫生科技发展计划项目（2016WS0549）。
- DOI：10.19401/j.cnki.1007-3639.2018.12.007
  中图分类号：
- 网络出版：2019-01-11，
  
  纸质出版：2019-01-11
- 稿件说明：
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石志强,邱鹏飞,丛斌斌,等. 临床淋巴结阴性乳腺癌新辅助化疗与腋窝降阶梯处理的研究[J]. 中国癌症杂志, 2018, 28(12): 922-927.

SHI Zhiqiang, QIU Pengfei, CONG Binbin. Neoadjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer[J]. China Oncology, 2018, 28(12): 922-927.
石志强,邱鹏飞,丛斌斌,等. 临床淋巴结阴性乳腺癌新辅助化疗与腋窝降阶梯处理的研究[J]. 中国癌症杂志, 2018, 28(12): 922-927. DOI： 10.19401/j.cnki.1007-3639.2018.12.007.

SHI Zhiqiang, QIU Pengfei, CONG Binbin. Neoadjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer[J]. China Oncology, 2018, 28(12): 922-927. DOI： 10.19401/j.cnki.1007-3639.2018.12.007.

摘要

背景与目的：前哨淋巴结活检（sentinel lymph node biopsy，SLNB）是临床淋巴结阴性（clinically nodenegative，cN

）早期乳腺癌患者诊断的标准，但对于新辅助化疗（neoadjuvant chemotherapy，NAC）的cN

患者行SLNB的时机仍存在争议。本研究旨在探讨cN

患者接受NAC与SLNB的最佳时机，评估其NAC后选择性避免腋窝手术的可行性。方法：回顾性分析2010年10月—2018年4月山东大学附属山东省肿瘤医院乳腺病中心收治的809例行NAC患者的临床病理学资料，分析138例cN

患者的不同临床病理学特征与NAC后腋窝淋巴结阴性（即ypN

）的相关性。结果：cN

患者NAC后81.9%（113/138）为ypN

。激素受体（hormone receptor positive，HR）阳性（+）/人表皮生长因子受体2（human epidermal growth factor receptor-2，HER2）阴性（-）、HR

/HER2

、HR-/HER2

，以及三阴性乳腺癌（triple-negative breast cancer，TNBC）患者NAC后ypN

率分别为75.4%（46/61）、81.0%（17/21）、79.2%（19/24）和96.9%（31/32）（P0.001）。HER2

患者接受靶向治疗、TNBC患者接受NAC后，ypN

率分别为94.1%（16/17）、96.9%（31/32），较HR

/HER2

患者显著增高（均P0.05）。乳房肿瘤的分子分型、临床分期、影像学完全缓解及病理完全缓解（breast pathologic complete response，bpCR）与NAC（行全疗程化疗）后ypN

显著相关（P均0.05），其中乳房肿瘤的分子分型（OR=0.454

P=0.049）、临床分期（OR=3.174，P=0.029）和bpCR（OR=0.337，P=0.016）是NAC后ypN

的独立预测因素。结论：不同分子分型cN

患者NAC与SLNB的最佳时机不同：HR

/HER2

患者接受NAC前行SLNB可降低腋窝淋巴结清扫（axillary lymph node dissection，ALND）的风险，而HER2

患者接受靶向治疗和TNBC患者NAC后行SLNB能更好地避免ALND。鉴于cN

患者NAC后的高ypN

率，尤以HER2

行靶向治疗及TNBC患者为著，使其NAC后选择性避免腋窝手术成为可能。

Abstract

Background and purpose: Sentinel lymph node biopsy (SLNB) is regarded as the standard of care in patients with clinically node-negative (cN

) disease in early-stage breast cancer

but the timing of SLNB and neoadjuvant chemotherapy (NAC) in cN

patients is still controversial. This study aimed to explore the optimal timing of SLNB and NAC

and to assess the feasibility of selective elimination of axillary surgery after NAC in cN

patients. Methods: From Oct. 2010 to Apr. 2018

809 patients who underwent surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN

patients and negative axillary lymph node conversion after NAC (ie

ypN

). Results: Among the 138 cN

patients receiving NAC

81.9% (113/138) were ypN

. The rates of ypN

after NAC in patients with hormone receptor positive (HR+)/ human epidermal growth factor receptor 2 negative (HER2

)

/HER2

and triple-negative breast cancer (TNBC) were 75.4% (15/61)

81.0% (17/21)

79.2% (19/24) and 96.9% (31/32)

respectively（P0.001）. The rates of ypN

after NAC in patients with HER2

(with targeted therapy) and TNBC were 94.1% (16/17) and 96.9% (31/32)

respectively

which were significantly higher than that in HR

/HER2

patients (P0.05). Molecular subtypes

clinical stage

radiologic complete response and pathologic complete response (bpCR) of the breast tumor correlated with ypN

after NAC (with full-course chemotherapy

P0.05). Molecular subtypes (OR=0.454

P=0.049)

clinical stage (OR=3.174

P=0.029) and bpCR (OR=0.337

P=0.016) of the breast tumor were independent predictors for ypN

after NAC. Conclusion: The

optimal timing of SLNB and NAC in cN

patients might be different among different molecular subtypes. It would be preferable to perform SLNB prior to NAC for HR

/HER2

patients

and SLNB after NAC for HER2

(with targeted therapy) and TNBC patients to reduce the risk of axillary lymph node dissection (ALND). In view of the high ypN

rate after NAC in cN

patients

axillary surgical staging might be selectively eliminated

especially in patients with HER2

(with targeted therapy) and TNBC.

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