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目的:探讨新辅助化疗对经细针针吸活检证实有腋窝淋巴结癌转移局部晚期乳腺癌的影响。方法:111例局部晚期乳腺癌经细针针吸活检确诊有腋窝淋巴结癌转移且空心针穿刺确诊为浸润性乳腺癌,接受≥2个周期标准剂量新辅助化疗后手术治疗。根据新辅助化疗后不同的腋窝淋巴结临床疗效和腋窝淋巴结病理状况,分组进行生存分析。结果:新辅助化疗后,腋窝淋巴结临床完全缓解(cCR)占60.4%(67/111),其中腋窝淋巴结病理完全缓解(pCR)占29.9%(20/67);未临床完全缓解(no-cCR)占39.6%(44/111),其中pCR占36.4%(16/44)。中位随访时间为65个月(13～76个月)。cCR与no-cCR两组的无病生存时间(DFS)和总生存时间(OS)差异均无统计学意义,P值分别为0.182和0.984。pCR患者具有较长DFS和OS,P值分别为0.036和0.038。pCR患者中,肿瘤原发灶pCR与no-pCR患者的DFS和OS差异均无统计学意义,P值分别为0.204和0.250。结论:对病理学确诊有腋窝淋巴结癌转移的局部晚期乳腺癌患者,单纯根据临床体检结合常规的腋窝B超检查评价腋窝淋巴结的临床疗效,可能难以准确地预测腋窝淋巴结的病理缓解状况和预后。腋窝淋巴结pCR患者的预后较好,与肿瘤原发灶是否达到pCR无关。
Objective: To investigate the effect of neoadjuvant chemotherapy on locally advanced breast cancer with axillary lymph node metastasis confirmed by fine needle aspiration biopsy. Methods: One hundred and 111 cases of locally advanced breast cancer were confirmed by fine needle aspiration biopsy with axillary lymph node metastasis and hollow needle aspiration for invasive breast cancer. The patients received ≥2 cycles of standard dose neoadjuvant chemotherapy after operation. According to different clinical efficacy of axillary lymph node after neoadjuvant chemotherapy and axillary lymph node pathological conditions, survival analysis was performed in groups. Results: After neoadjuvant chemotherapy, the complete remission (cCR) of axillary lymph nodes accounted for 60.4% (67/111), of which 29.9% (20/67) achieved axillary lymph node complete remission (pCR); no clinical complete remission ) Accounted for 39.6% (44/111), among which pCR accounted for 36.4% (16/44). The median follow-up time was 65 months (range, 13 to 76 months). There was no significant difference in disease-free survival time (DFS) and overall survival time (OS) between cCR and no-cCR groups, with P values of 0.182 and 0.984, respectively. Patients with pCR had longer DFS and OS with P values of 0.036 and 0.038, respectively. There was no significant difference in DFS and OS between patients with pCR and no-pCR in patients with primary pCR, with P values of 0.204 and 0.250, respectively. Conclusions: The clinical efficacy of axillary lymph nodes in clinical evaluation of axillary lymph nodes based on clinical examination combined with conventional axillary biopsy can not accurately predict the pathological remission status and prognosis of axillary lymph nodes in patients with locally advanced breast cancer with pathologically confirmed axillary lymph node metastases. Axillary lymph node pCR patients with good prognosis, and whether the primary tumor has reached pCR.