术前全身新辅助治疗后，腋窝淋巴结残癌是乳房切除术后放疗的决定因素。术前确定哪些患者需要乳房切除术后放疗，对于医患共同决策选择乳房重建最佳时机至关重要。
7月29日，美国乳腺外科医师学会和美国肿瘤外科学会《肿瘤外科学报》在线发表荷兰综合癌症组织、马斯特里赫特大学、特文特大学的研究报告，探讨了临床淋巴结阴性乳腺癌全身新辅助治疗后前哨淋巴结阳性风险对乳房切除术后放疗和即刻乳房重建的影响。
该研究对～荷兰癌症登记中心所有临床T1～3期淋巴结阴性乳腺癌接受术前全身新辅助治疗后乳房切除术和前哨淋巴结活检的788例患者进行回顾分析，确定不同乳腺癌亚型的前哨淋巴结阳性率。通过逻辑回归模型分析，确定前哨淋巴结阳性相关临床病理因素。
结果，前哨淋巴结阳性患者197例（25.0%）
ER阳性HER2阳性、ER阴性HER2阳性、临床T1～2期三阴性乳腺癌患者的前哨淋巴结阳性率最低：7.2～11.5%、0～6.3%、2.9～6.2%。
ER阳性HER2阴性、临床T3期三阴性乳腺癌患者的前哨淋巴结阳性率最高：23.8～41.7%、30.4%
根据多因素回归模型分析，前哨淋巴结阳性风险：
临床T2期：高1.93倍（95%置信区间：1.01～3.96，P=0.047）
临床T3期：高2.56倍（95%置信区间：1.30～5.38，P=0.006）
3级比1级：低0.44倍（95%置信区间：0.21～0.91，P=0.026）
ER阳性HER2阴性：高3.94倍（95%置信区间：1.77～8.74，P=0.001）
因此，该研究结果表明，临床T1～3期淋巴结阴性乳腺癌术前全身新辅助治疗后：对于ER阳性HER2阳性、ER阴性HER2阳性、临床T1～2期三阴性患者，由于前哨淋巴结阳性风险较低，可以考虑选择即刻重建；对于ER阳性HER2阴性、临床T3期三阴性患者，由于前哨淋巴结阳性风险相对较高，应与患者讨论即刻重建的风险和获益。
Ann Surg Oncol. Jul 29. [Epub ahead of print]
Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction.
S. Samiei, B. N. van Kaathoven, L. Boersma, R. W. Y. Granzier, S. Siesling, S. M. E. Engelen, L. de Munck, S. M. J. van Kuijk, R. R. J. W. van der Hulst, M. B. I. Lobbes, M. L. Smidt, T. J. A. van Nijnatten.
Maastricht University Medical Center, Maastricht, The Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; University of Twente, Enschede, The Netherlands.
BACKGROUND: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer.
METHODS: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between and were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN.
RESULTS: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER-HER2+, and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2-11.5%, 0-6.3%, and 2.9-6.2%, respectively. cT1-3N0 ER+HER2- and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8-41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01-3.96), cT3 (OR 2.56; 95% CI 1.30-5.38), grade 3 (OR 0.44; 95% CI 0.21-0.91), and ER+HER2- subtype (OR 3.94; 95% CI 1.77-8.74) were correlated with positive SLN.
CONCLUSIONS: In cT1-3N0 ER+HER2+, cT1-3N0 ER-HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2- and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.
DOI: 10.1245/s10434-019-07643-x
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