乳腺癌内乳前哨淋巴结活检与患者预后的相关性研究

贾瑞杰; 石志强; 张琦; 逯永晋; 郑竣升; 孙菁; 毕钊; 孙晓; 王永胜; 邱鹏飞

doi:10.19401/j.cnki.1007-3639.2025.04.007

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乳腺癌内乳前哨淋巴结活检与患者预后的相关性研究

论著 | 更新时间：2025-12-31

- 乳腺癌内乳前哨淋巴结活检与患者预后的相关性研究
- Research on the association of breast cancer patients’ prognosis with internal mammary sentinel lymph node biopsy
- 中国癌症杂志 2025年35卷第4期页码：394-403
- 作者机构：
  
  1. 山东第一医科大学附属肿瘤医院（山东省肿瘤防治研究院、山东省肿瘤医院），山东济南 250117
  2. 山东第一医科大学（山东省医学科学院），山东济南 250118
  3. 天津医科大学肿瘤医院，天津 300000
- 作者简介：
  
  [ "贾瑞杰（ORCID: 0009-0007-7971-1540），山东第一医科大学硕士研究生。" ]
  邱鹏飞（ORCID: 0000-0001-6784-410X），博士，主任医师，山东第一医科大学附属肿瘤医院乳腺外科副主任。
- 基金信息：
  
  国家自然科学基金(82172873);国际（地区）合作与交流项目(W2421095);山东省泰山学者计划(tsqn202211337);济南市科技计划(202430063)
- DOI：10.19401/j.cnki.1007-3639.2025.04.007
  中图分类号：
- 收稿：2025-01-06，
  
  修回：2025-03-20，
  
  纸质出版：2025-04-30
- 稿件说明：
移动端阅览
贾瑞杰, 石志强, 张琦, 等. 乳腺癌内乳前哨淋巴结活检与患者预后的相关性研究[J]. 中国癌症杂志, 2025,35(4):394-403.

Ruijie JIA, Zhiqiang SHI, Qi ZHANG, et al. Research on the association of breast cancer patients’ prognosis with internal mammary sentinel lymph node biopsy[J]. China Oncology, 2025, 35(4): 394-403.
贾瑞杰, 石志强, 张琦, 等. 乳腺癌内乳前哨淋巴结活检与患者预后的相关性研究[J]. 中国癌症杂志, 2025,35(4):394-403. DOI： 10.19401/j.cnki.1007-3639.2025.04.007.

Ruijie JIA, Zhiqiang SHI, Qi ZHANG, et al. Research on the association of breast cancer patients’ prognosis with internal mammary sentinel lymph node biopsy[J]. China Oncology, 2025, 35(4): 394-403. DOI： 10.19401/j.cnki.1007-3639.2025.04.007.

摘要

背景与目的：

乳腺癌内乳前哨淋巴结活检术（internal mammary sentinel lymph node biopsy，IMSLNB）是区域淋巴结微创诊断技术，可以提供准确的淋巴结分期并指导辅助治疗决策，但其对患者预后的影响尚不明确，导致临床应用一直存在争议。本研究旨在探讨IMSLNB在早期乳腺癌中的预后结果。

方法：

本研究为单中心回顾性队列研究，纳

入了2016年1月1日—2021年12月31日于我院就诊的7 949例乳腺癌患者，应用倾向性评分匹配后，将患者分为IMSLNB组和no-IMSLNB组，比较两组患者的预后情况，主要研究终点为无病生存期（disease-free survival，DFS），次要研究终点为总生存期（overall survival，OS）、无区域复发生存期（regional recurrence-free survival，RRFS）、无局部复发生存期（local recurrence-free survival，LRFS）和无远处转移生存期（distant metastasis-free survival，DMFS）。本研究经山东第一医科大学附属肿瘤医院临床研究伦理委员会批准（编号：SDTHEC20130324）。

结果：

990例患者纳入最终分析（IMSLNB组330例，no-IMSLNB组660例），IMSLNB组54例患者发现IMSLN转移，IMSLN转移率为16.4%；其中47例伴腋窝淋巴结（axillary lymph node，ALN）转移、7例仅IMSLN转移。中位随访时间41个月结果显示，IMSLNB组3年DFS（98.4%

94.2%，HR=0.509，95% CI: 0.312~0.828，

=0.007）和5年DFS（92.5%

87.3%，HR=0.214，95% CI：0.206~0.222，

=0.011）均显著优于no-IMSLNB组，但3年OS（99.1%

99.4%，HR=0.618，95% CI: 0.231~1.655，

=0.338）和5年OS（98.5%

99.1%，HR=0.52，95% CI：0.51~0.53，

=0.392）差异无统计学意义。IMSLNB组3年RRFS显著优于no-IMSLNB组（99.09%

97.73%，HR=0.066，95% CI：0.061~0.071，

=0.048），但3年LRFS（99.70%

98.19%，HR=0.209，95% CI：0.201~0.217，

=0.130）和DMFS（95.76%

96.06%，HR=0.865，95% CI：0.858~0.872，

=0.820）在两组间差异均无统计学意义。DFS的探索性亚组分析显示，诊断年龄（≤50岁）、绝经状态（绝经前）、体重指数（body mass index，BMI）（≤24）、淋巴管血管侵犯（lymphatic vessel infiltration，LVI）（是）、肿瘤位置（外侧）、分子分型[激素受体阳性（hormone receptor positive，HR

）/人表皮生长因子受体阴性（human epidermal growth factor receptor 2 negative，HER2

）

]

、病理学类型（浸润性导管癌）和ALN状态（阳性）各亚组患者可从IMSLNB显著获益（

0.05）。

结论：

IMSLNB可以为早期乳腺癌患者提供更为准确的区域淋巴结分期，优化辅助放疗策略从而改善患者的RRFS和DFS，可作为区域淋巴结的微创分期技术推广应用。

Abstract

Background and purpose:

Internal mammary sentinel lymph node biopsy (IMSLNB) is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer

which can provide accurate lymph staging and guide adjuvant treatment decision

but its clinical application has been controversial. The pu

rpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.

Methods:

In this study

a retrospective cohort of 7 949 patients with breast cancer from January 1

2016 to December 31

2021 was analyzed. After applying propensity score matching

the patients were divided into IMSLNB group and no-IMSLNB group

and the regional recurrence -free survival (RRFS)

local recurrence-free survival (LRFS)

distant metastasis-free survival (DMFS)

disease-free survival (DFS) and overall survival (OS) of the two groups were compared. This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University (approval number: SDTHEC20130324).

Results:

A total of 990 patients were included in the final analysis (330 in the IMSLNB group and 660 in the no-IMSLNB group). IMSLN metastasis was found in 54 patients in the IMSLNB group

including 47 patients with axillary lymph node (ALN) metastasis and 7 patients with IMSLN metastasis only. The IMSLN transfer rate was 16.4%. The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS [98.4%

94.2%

hazard ratio (HR)=0.509; 95% CI: 0.312-0.828

=0.007

]

and 5-year DFS (92.5%

87.3%

HR=0.214

95% CI: 0.206-0.222

=0.011) compared with no-IMSLNB group. However

no significant differences were observed in 3-year OS (99.1%

99.4%

HR=0.618

95% CI: 0.231-1.655

=0.338) or 5-year OS (98.5%

99.1%

HR=0.52

95% CI: 0.51-0.53

=0.392) between the two groups. The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group (99.09%

97.73%

HR=0.066; 95% CI: 0.061-0.071

=0.048)

while no significant differences were observed in 3-year LRFS (99.70%

98.19%

HR=0.209; 95% CI: 0.201-0.217

=0.130) or DMFS (95.76%

96.06%

HR=0.865

95% CI: 0.858-0.872

=0.820) between the two groups. The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB (

0.05): diagnosis age (≤50 years)

premenopausal status

BMI (≤24)

lymphovascular invasion (LVI

present)

tumor location (lateral)

molecular subtype [hormone receptor positive (HR

)/ human epidermal growth factor receptor 2 negative (HER2

)

]

histological type (invasive ductal carcinoma)

and axillary lymph node status (positive).

Conclusion:

IMSLNB can provide more accurate regional lymph node staging for early breast cancer

help optimize adjuvant radiotherapy strategies

and improve patients’ DFS and RRFS. It can be promoted as a minimally invasive staging technique for regional lymph nodes.

关键词

Keywords

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