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目的探讨我国1~2枚前哨淋巴结(SLN)阳性乳腺癌患者避免腋窝淋巴结清扫(ALND)的可行性。方法回顾性收集2010–2016年间于笔者所在医院院行前哨淋巴结活检(SLNB)的328例患者,将符合Z0011试验结果(未接受新辅助治疗,临床肿瘤分期为T1/T2期,SLN阳性数目为1~2枚,行保乳手术、术后接受全乳放疗和全身辅助治疗)的病例设定为保乳组;将除手术方式之外,其余均满足Z0011试验结果的病例设为非保乳组,将保乳组和非保乳组患者的临床病理学特征与Z0011 ALND组进行比较。结果 328例患者中,仅29例(8.8%)完全符合Z0011试验结果。保乳组和Z0011 ALND组患者的年龄、肿瘤T分期、雌激素受体(ER)表达、孕激素受体(PR)表达、病理学类型、组织学分级、阳性淋巴结数量和非前哨淋巴结(NSN)转移情况比较差异均无统计学意义(P>0.05)。81例患者归入非保乳组,非保乳组和Z0011 ALND组患者的ER表达、PR表达及组织学分级比较差异均无统计学意义(P>0.05),但2组患者的年龄、肿瘤T分期、病理学类型、阳性淋巴结数量及NSN转移情况比较差异均有统计学意义(P<0.05),非保乳组患者的年龄较小,T2期比例较高,小叶癌比例高、导管癌比例低,阳性淋巴结多,NSN转移率高。结论 Z0011试验结果可用于我国的临床实践,但根据我国的实际保乳情况可能导致受适人群比例偏低。
Objective To investigate the feasibility of avoiding axillary lymph node dissection (ALND) in 1-2 SLN-positive breast cancer patients in China. Methods A retrospective review of 328 patients with sentinel lymph node biopsy (SLNB) at our hospital from 2010 to 2016 was performed in accordance with the results of Z0011 (no neoadjuvant therapy, clinical stage T1 / T2, SLN positive 1 to 2, breast-conserving surgery, postoperative whole-breast radiotherapy and systemic adjuvant therapy) was set as a breast-conserving group; except for the surgical method, all the other cases that met the Z0011 test result were set as non- Group, clinical and pathological features of the breastfed and non-breastfed patients were compared with the Z0011 ALND group. Results Of the 328 patients, only 29 (8.8%) were fully consistent with the Z0011 test results. The age, tumor T stage, estrogen receptor (ER) expression, progesterone receptor (PR) expression, pathological type, histological grade, number of positive lymph nodes and non-sentinel lymph nodes (NSNs) in breastfeeding and Z0011 ALND patients ) Metastasis were no significant difference (P> 0.05). There were no significant differences in ER expression, PR expression and histological grade among 81 breast cancer patients, non-breast-conservation breast cancer patients and Z0011 ALND patients (P> 0.05). However, the age, T stage, pathological type, number of positive lymph nodes and metastasis of NSN were statistically significant (P <0.05), non-conservative group of patients with younger age, higher proportion of T2, lobular cancer, a high proportion of ductal carcinoma Low proportion of positive lymph nodes, NSN metastasis rate. Conclusion Z0011 test results can be used in clinical practice in our country, but according to the actual situation of breast-conserving in our country may lead to a lower proportion of the appropriate population.