新辅助治疗对雌激素受体低表达/人类表皮生长因子受体2阳性乳腺癌腋窝淋巴结状态的影响

目的评估人类表皮生长因子受体2(HER2)阳性乳腺癌患者接受不同新辅助治疗(NAC)方案后腋窝淋巴结病理缓解情况及影响因素。方法纳入2010年11月至2015年12月中山市人民医院收治的100例HER2阳性、Ⅱa~Ⅲc期乳腺癌患者,在NAC前通过触诊和细针穿刺(FNA)评估腋窝淋巴结状态。所有患者接受4~6个周期的PCrb(紫杉醇175 mg/m^2和卡铂AUC=6,每3周),部分患者接受联合曲妥珠单抗(6 mg/kg每3周,首剂8 mg/kg)。结果 62例通过FNA确定为腋窝淋巴结阳性(A组),38例通过FNA或触诊确定为腋窝淋巴结阴性(B组)。其中A组总体腋窝淋巴结病理阴性率(pNNR)为53.2%,B组为71.1%。雌激素受体(ER)低表达/HER2阳性患者的pNNR最高,A组为81.0%,B组86.7%。多因素分析显示,联合曲妥珠单抗和ER状态是预测HER2阳性乳腺癌pNNR的独立因素。结论对于治疗前腋窝淋巴结阳性的乳腺癌患者,如果NAC联合靶向治疗后前哨淋巴结阴性,ER低表达/HER2阳性就不需要腋窝淋巴结清扫。

Influence of neoadjuvant chemotherapy on axillary lymph node dissection in axillary lymph node positive,ER-negative/HER2-positive breast cancer

ObjectiveTo evaluate the pathological response and influencing factors of axillary lymph nodes in patients with ER-negative/HER2-positive breast cancer after neoadjuvant therapy. MethodsFrom November 2010 to December 2015, one hundred patients with HER2-positive, stage Ⅱa-Ⅲc breast cancer in Zhongshan City People’s Hospital were enrolled and evaluated for axillary status by palpation and fine needle aspiration (FNA) before neoadjuvant chemotherapy (NAC). All patients received 4-6 cycles of PCrb (paclitaxel 175 mg/m² and carboplatin AUC=6 every 3 weeks), and some patients combined with trastuzumab (6 mg/kg every 3 weeks). ResultsSixty-two patients were confirmed positive axillary lymph nodes by FNA (group A), and thirty-eight patients were considered negative axillary lymph nodes by FNA or palpation (group B). The axillary lymph node pathological negative node rate (pNNR) was 53.2% in group A and 71.1% in group B. The pNNR of ER-negative/HER2-positive was the highest (81.0% in group A and 86.7% in group B). In multivariate analysis, combined trastuzumab and ER status were independent factors predicting pNNR in HER2-positive breast cancer. ConclusionFor breast cancer patients with positive lymph nodes before NAC, the ER-negative/ HER2-positive subtype is a potential type of patients with negative sentinel lymph nodes that do not require axillary lymph node dissection after NAC combined with targeted therapy.