CAJ | 학술논문

背景与目的：美国外科医师学会肿瘤学组(American College of Surgeons Oncology Group， ACOSOG)Z0011试验的结果改变了乳腺癌前哨淋巴结(sentinel lymph node，SLN)阳性患者的传统治疗模式。本研究的目的在于探讨ACOSOG Z0011试验标准用于中国前哨淋巴结阳性乳腺癌患者以避免腋窝淋巴结清扫(axillary lymph node dissection，ALND)的可行性。方法：连续收集194例SLN阳性的乳腺癌患者，根据Z0011的标准分为可以只做前哨淋巴结活检(sentinel lymph node biopsy，SLNB)组和仍需做ALND组。将SLNB组患者的临床病理学特征与Z0011试验标准的原始入组人群进行比较,再将SLNB组与ALND组患者的临床病理学特征进行比较。结果：194例患者中有77例符合Z0011标准可以只做SLNB，117例患者不符合Z0011标准，需要做ALND；SLNB组患者与Z0011标准原始入组人群比较，T1期肿瘤、ER阳性肿瘤、淋巴结转移数目少的肿瘤、非前哨淋巴结(non-sentinel lymph node，NSLN)阴性的肿瘤都显著多于Z0011标准原始人群，差异有统计学意义(P<0.05)。本研究ALND组患者与SLNB组患者比较，T2、T3期肿瘤较多，但差异无统计学意义(P>0.05)。ALND组腋窝淋巴结转移数目多的患者比例要明显多于SLNB组，NSLN阳性患者比例也高于SLNB组，差异均有统计学意义(P<0.05)。结论：将Z0011试验标准用于SLN阳性乳腺癌患者，能够筛选出较Z0011标准研究中预后更好、更为低危的患者，使得该部分患者可以更为安全的只接受SLNB。
배경여목적：미국외과의사학회종류학조(American College of Surgeons Oncology Group， ACOSOG)Z0011시험적결과개변료유선암전초림파결(sentinel lymph node，SLN)양성환자적전통치료모식。본연구적목적재우탐토ACOSOG Z0011시험표준용우중국전초림파결양성유선암환자이피면액와림파결청소(axillary lymph node dissection，ALND)적가행성。방법：련속수집194례SLN양성적유선암환자，근거Z0011적표준분위가이지주전초림파결활검(sentinel lymph node biopsy，SLNB)조화잉수주ALND조。장SLNB조환자적림상병이학특정여Z0011시험표준적원시입조인군진행비교,재장SLNB조여ALND조환자적림상병이학특정진행비교。결과：194례환자중유77례부합Z0011표준가이지주SLNB，117례환자불부합Z0011표준，수요주ALND；SLNB조환자여Z0011표준원시입조인군비교，T1기종류、ER양성종류、림파결전이수목소적종류、비전초림파결(non-sentinel lymph node，NSLN)음성적종류도현저다우Z0011표준원시인군，차이유통계학의의(P<0.05)。본연구ALND조환자여SLNB조환자비교，T2、T3기종류교다，단차이무통계학의의(P>0.05)。ALND조액와림파결전이수목다적환자비례요명현다우SLNB조，NSLN양성환자비례야고우SLNB조，차이균유통계학의의(P<0.05)。결론：장Z0011시험표준용우SLN양성유선암환자，능구사선출교Z0011표준연구중예후경호、경위저위적환자，사득해부분환자가이경위안전적지접수SLNB。
Background and purpose:The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has been described as practice-changing of sentinel lymph node (SLN) positive breast cancers. The goal of this study was to determine the exportability of the criteria deifned by Z0011 trial for selecting patients who are eligible for avoiding axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) result in China.Methods:We collected 194 breast cancer patients with positive SLNs and classiifed them into two groups according to Z0011 criteria. One group was consisted of patients who were eligible for omitting ALND and with SLNB only. The other one was ALND group. Then the patients of SLNB group were compared with cohort included in the Z0011 trial and the ALND group of this study separately.Results:Seventy-seven patients were potentially eligible for omitting ALND and 117 patients were still needed to have ALND. Compared with Z0011 cohort, the SLNB group in this research had signiifcantly more T1 stage and ER positive tumors (P<0.05). More patients in SLNB group had positive LNs with the number less than 3 and negative NSLNs (P<0.05). The ALND group had more T2 and T3 stage tumors than the SLNB group but the difference was not signiifcantly. The number of positive LNs in ALND group was higher than the SLNB group signiifcantly (P<0.05). More patients in the ALND group had positive non-sentinel lymph node (NSLN) than the SLNB group and the difference was also signiifcantly (P<0.05).Conclusion:Applied to the SLN positive patients in this study, Z0011 criteria could make patients with better prognosis and lower risk than Z0011 cohort be selected and let these patients avoiding ALND more safely.