中国癌症杂志2025，Vol.35Issue(4)：394-403,10.DOI:10.19401/j.cnki.1007-3639.2025.04.007
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
摘要
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 purpose 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%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=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(P＜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
乳腺癌/内乳淋巴结/前哨淋巴结活检/个体化治疗/预后Key words
Breast cancer/Internal mammary lymph nodes/Sentinel lymph node biopsy/Individualized therapy/Prognosis引用本文复制引用
贾瑞杰,邱鹏飞,石志强,张琦,逯永晋,郑竣升,孙菁,毕钊,孙晓,王永胜..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):394-403,10.基金项目
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). National Natural Science Foundation of China(82172873) （82172873）
International(Regional)Cooperation and Exchange Project(W2421095) （Regional）
Shandong Province Taishan Scholars Program of(tsqn202211337) （tsqn202211337）
Jinan Science and Technology Plan(202430063).Conflicts of interest:authors declare no conflicts of interest. （202430063）
