早期乳腺癌前哨淋巴结阴性患者行腋窝淋巴结清扫的预后分析

目的比较早期乳腺癌前哨淋巴结（SLN）阴性患者仅行前哨淋巴结活检术（SLNB）和SLNB后加腋窝淋巴结清扫术（ALND）的术后并发症及远期预后差异。 方法回顾性分析2005年1月至2010年12月461例SLN阴性的早期乳腺癌患者的临床和病理资料，其中241例仅行SLNB的患者为非腋窝淋巴结清扫组（NALND组），220例加行ALND者为腋窝淋巴结清扫组（ALND组）。比较两组患者的术后并发症情况和远期疗效。 结果NALND组和ALND组术后平均住院天数为（5.2±1.3）d和（8.1±1.8）d（t=1.450，P=0.003），术后6个月患侧上肢感觉异常分别为3.7%（9/241）和73.2%（161/220）（χ²=283.239，P<0.000 1），患侧上肢水肿发生率分别为0（0/241）和10.9%（24/220）（χ²=7.735，P<0.000 1），差异均有统计学意义。两组5年无病生存率分别为95.4%和95.5%（χ²=0.231，P=0.902），差异无统计学意义。 结论对于SLN阴性早期乳腺癌患者，不行ALND较ALND手术创伤小，术后并发症少，且远期疗效可与ALND相媲美，本研究结论支持SLN阴性的早期乳腺癌患者无须进行ALND术。

Prognosis of early breast cancer sentinel lymph node negative patients with axillary lymphadenec-tomy

ObjectiveTo compare the prognosis of early breast cancer patients with negative sentinel lymph nodes (SLN) treated only by sentinel lymph node biopsy (SLNB) and SLNB plus axillary lymph node dissection (ALND). MethodsA retrospective analysis of early breast cancer patients in our hospital from January 2005 to December 2010 with negative SLN (only SLNB in 241 cases and SLNB+ALND in 220 cases) was carried out. According to the clinical and pathological data, we compared postop-erative complications and long-term prognosis in the two groups. ResultsThe average postoperative hos-pital stay of NALND group and ALND group was (5.2±1.3) d and (8.1±1.8) d (t=1.450, P=0.003), respec-tively, upper extremity with abnormal sensation after resection was 3.7% (9/241) and 73.2% (161/220) (χ²=283.239, P<0.000 1), and upper limb edema was 0 (0/241) and 10.9% (24/220) (χ²=7.735, P<0.000 1), and the differences were statistically significant. 5-year disease free survival rates of two groups were 95.4% and 95.5% (χ²=0.231, P=0.902). ConclusionsPatients undergoing only SLNB without ALND has less trauma and less postoperative complications than ALND in early breast cancer of negative SLN, and the long-term efficacy is comparable to ALND. We propose it is not necessary to carry out ALND for early breast cancer patients with negative SLN.