글로벌 연구동향
방사선종양학
- 2023년 05월호
[Eur J Surg Oncol .] Omission of axillary lymph node dissection in patients with ypN+ breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06)선행항암치료를 받은 림프절양성 유방암 환자에서 겨드랑이 림프절 절제수술 생략에 대한 다기관 임상연구이화의대, 서울의대 / 박영희, 신영섭, 김규보*, 신경환*
- 출처
- Eur J Surg Oncol .
- 등재일
- 2023 Mar
- 저널이슈번호
- 49(3):589-596.
- 내용
Abstract
Background: We evaluated the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC).Methods: The medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. In total, 1273 patients from 12 institutions were included; all underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%). Univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed before and after propensity score matching (PSM).
Results: The median follow-up was 75.3 months (range, 2.5-182.7). Axillary recurrence rates were 4.8% in the ALND group (n = 53) and 4.7% in the SLNBx group (n = 8). Before PSM, univariate analysis indicated that the 5-year OS rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002); multivariate analysis did not show a difference between groups (P = 0.325). After PSM, 258 and 136 patients were included in the ALND and SLNBx groups, respectively. There were no significant differences between the ALND and SLNBx groups in DFS (5-year rate, 75.8% vs. 76.9%, respectively; P = 0.406) or OS (5-year rate, 88.7% vs. 93.1%, respectively; P = 0.083).
Conclusions: SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.
Affiliations
Younghee Park 1, Young Seob Shin 2, Kyubo Kim 3, Kyung Hwan Shin 4, Ji Hyun Chang 5, Su Ssan Kim 2, Jin Hong Jung 2, Won Park 6, Haeyoung Kim 6, Yong Bae Kim 7, Sung Ja Ahn 8, Myungsoo Kim 9, Jin Hee Kim 10, Hye Jung Cha 11, Tae Gyu Kim 12, Hae Jin Park 13, Sun Young Lee 14
1Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea.
2Department of Radiation Oncology, University of Ulsan College of Medicine, South Korea.
3Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea. Electronic address: kyubokim.ro@gmail.com.
4Department of Radiation Oncology, Seoul National University College of Medicine, South Korea. Electronic address: radiat@snu.ac.kr.
5Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
6Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
7Department of Radiation Oncology, Yonsei University College of Medicine, South Korea.
8Department of Radiation Oncology, Chonnam National University Medical School, South Korea.
9Department of Radiation Oncology, The Catholic University of Korea College of Medicine, South Korea.
10Department of Radiation Oncology, Keimyung University School of Medicine, South Korea.
11Department of Radiation Oncology, Yonsei University Wonju College of Medicine, South Korea.
12Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, South Korea.
13Department of Radiation Oncology, Hanyang University College of Medicine, South Korea.
14Department of Radiation Oncology, Jeonbuk National University School of Medicine, South Korea.
- 키워드
- Axillary lymph node dissection; Breast cancer; Neoadjuvant chemotherapy; Residual nodal disease; Sentinel lymph node biopsy.
- 덧글달기
편집위원
유방암에서 선행항암화학요법 후에도 림프절전이가 병리학적으로 확인된 경우, 현재까지의 표준치료는 림프절절제술을 시행하는 것이지만, 선택적으로 감시림프절생검만 시행하는 것이 치료성적을 악화시키지 않음을 다기관 후향적 분석을 통해 제시한 논문
덧글달기닫기2023-05-08 16:55:49
등록
편집위원2
후향적 연구이지만 대규모 다기관 연구로 선행항암화학요법 후 LN(+)환자에서 SLNB와 ALND 환자군에서 PMS 전에는 ALND 환자군이 낮은 생존율을 보였지만 PMS후에는 차이가 없음을 보여주었습니다.
덧글달기닫기2023-05-08 16:56:14
등록