新辅助化疗后根据腋窝淋巴结病理学完全缓解确定治疗有效率

　　淋巴结阳性乳腺癌患者新辅助化疗后，当阴性前哨淋巴结≥3时，前哨淋巴结活检假阴性率＜10%。已有建议标记阳性淋巴结以减少假阴性率。新辅助化疗后在淋巴结中确定治疗效果是减少假阴性率的可选方法。

　　2016年7月28日，美国乳腺外科医师学会和外科肿瘤学会官方期刊《外科肿瘤学年鉴》在线发表纽约纪念斯隆-凯特林癌症中心的研究报告，评估了淋巴结阳性患者新辅助化疗病理学完全缓解后的治疗有效率。

　　该研究选择活检证实淋巴结阳性患者接受新辅助化疗，对腋窝淋巴结清扫或双示踪前哨淋巴结活检后并且清除前哨淋巴结≥3的淋巴结病理学完全缓解患者治疗效果进行评估，对腋窝淋巴结清扫和前哨淋巴结活检的患者进行比较。

　　结果，2009年1月至2015年12月接受新辅助化疗的淋巴结阳性患者共有528位，中位年龄为49岁，15%为激素受体阳性/HER2阴性，27%为三阴性，58%为HER2阳性。其中，204例淋巴结病理学完全缓解，135例行腋窝淋巴结清扫，69例行前哨淋巴结活检。腋窝淋巴结清扫患者与前哨淋巴结活检患者相比，淋巴结清除中位数为17比4。192例（94%）淋巴结的治疗效果确定，腋窝淋巴结清扫多于前哨淋巴结活检患者（97%比88%，P=0.02）。激素受体阳性患者和无乳腺病理学完全缓解患者的淋巴结治疗不太可能有效（P=0.05）。其他特性无区别。

　　因此，新辅助化疗后，88%的患者前哨淋巴结治疗有效。尚需较长时间随访确定仅行前哨淋巴结队列的局部复发率。

Ann Surg Oncol. 2016 Jul 28. [Epub ahead of print]

How Often Is Treatment Effect Identified in Axillary Nodes with a Pathologic Complete Response After Neoadjuvant Chemotherapy?

Barrio AV, Mamtani A, Edelweiss M, Eaton A, Stempel M, Murray MP, Morrow M.

Memorial Sloan Kettering Cancer Center, New York, NY, USA.

BACKGROUND: False-negative rates (FNR) of sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC) in node-positive (N+) breast cancer patients are <10 % when ≥3 negative SNs are obtained. Marking positive nodes has been suggested to reduce FNR. Identification of treatment effect in the nodes post-NAC is an alternative to decrease FNR. We evaluated the frequency of treatment effect in N+ patients after a pathologic complete response (pCR) with NAC.

METHODS: Biopsy-proven N+ patients receiving NAC were identified. Patients with nodal pCR after axillary lymph node dissection (ALND) or SNB with dual mapping and ≥3 SNs removed were evaluated for treatment effect; ALND and SNB patients were compared.

RESULTS: From January 2009 to December 2015, 528 N+ patients received NAC. Of these, 204 had a nodal pCR, 135 had an ALND, and 69 had SNB. Median age was 49 years, 15 % were hormone receptor positive (HR+)/HER2-, 27 % triple negative, and 58 % HER2+. The median number of nodes removed in ALND patients was 17 versus 4 in SNB patients. Treatment effect in nodes was identified in 192 patients (94 %) and was more common in ALND versus SNB patients (97 vs 88 %; p = .02). HR+ patients and patients without a breast pCR were less likely to have treatment effect in the nodes (p = .05). Other characteristics did not differ.

CONCLUSIONS: Following NAC, SNs with treatment effect were retrieved in 88 % of patients without marking nodes, suggesting that nodal clipping may not be necessary to achieve an acceptable FNR. Longer follow-up is needed to determine regional recurrence rates in the SN-only cohort.

PMID: 27469123

DOI: 10.1245/s10434-016-5463-1