B7-H4在乳腺癌组织中的表达及其与患者新辅助化疗后腋窝淋巴结转移的相关性分析

目的 探究B7同源体4(B7-H4)在乳腺癌组织中的表达及其与患者新辅助化疗后腋窝淋巴结转移的相关性。方法 选取2020年1月—2022年6月在我院接受新辅助化疗的82例乳腺癌患者为研究对象,采用活组织检查法评估肿瘤的病理类型,经新辅助化疗及乳腺癌改良根治术后获取乳腺癌组织和癌旁正常组织样本,采用免疫组化分析组织中B7-H4的表达。根据术后患者的病理确诊情况分为腋窝淋巴结转移组和腋窝淋巴结未转移组,采用单因素及多因素logistic回归分析影响新辅助化疗后淋巴结转移情况的因素。采用受试者工作特征(ROC)曲线分析B7-H4对乳腺癌患者新辅助化疗后腋窝淋巴结转移的诊断价值。构建列线图模型,采用ROC曲线和校准曲线对列线图模型的区分度和准确性进行验证。结果 B7-H4在乳腺癌组织中的阳性表达率高于癌旁组织(85.37%vs. 9.76%,P<0.05)。多因素logistic回归分析结果显示,B7-H4表达情况、术前腋窝淋巴结阳性数目、新辅助化疗疗效、新辅助化疗后肿瘤T分期、ER状态、HER2状态、Ki-67表达情况和化疗完成周期数均为乳腺癌患者新辅助化疗后腋窝淋巴结转移的危险因素(...     

乳腺癌新辅助化疗后前哨淋巴结活检的临床意义

目的探讨新辅助化疗后乳腺癌前哨淋巴结活检的可行性。方法对57例行^99Tc联合亚甲蓝示踪前哨淋巴结活检术和腋窝淋巴结清扫术乳腺癌患者的资料进行分析,其中31例ⅡB、Ⅲ期患者先行2～3个疗程新辅助化疗后再行前哨淋巴结活检及腋窝淋巴结清扫术,另26例Ⅰ、Ⅱ期患者直接行前哨淋巴结活检及腋窝淋巴结清扫术。结果新辅助化疗组和非新辅助化疗组平均腋窝淋巴结数、前哨淋巴结（sentinel lymph node,SLN）数、SLN检出率、SLN假阴性率均无显著差异（P均〉0．05）。新辅助化疗纽化疗前临床分期在N2以上者,SLN检出率均显著下降（P〈0．05）。结论新辅助化疗后前哨淋巴结活检能准确预测腋窝淋巴结的状况。化疗前的N分期是SLNB检出率的影响因素。     

新辅助化疗后腋窝淋巴结阴性乳腺癌术后放疗的研究进展

近年来,新辅助化疗越来越多地应用到局部晚期和早期乳腺癌患者的治疗中,且在一定程度上改善了疾病的病理状态和分期,这使乳腺癌患者新辅助化疗后术后放疗的决策更为复杂。现有指南已指出新辅助化疗后腋窝淋巴结阳性的患者推荐行术后放疗。但是在新辅助化疗后达病理完全缓解或腋窝淋巴结转阴的患者中术后放疗尚存在争议。放疗可以提高患者的局部...     

乳腺癌新辅助化疗后腋窝淋巴结状态的评估

新辅助化疗或新辅助化疗联合生物靶向治疗日趋成为局部晚期乳腺癌(Ⅱb~Ⅲ)的标准治疗方式,除了能降低原发肿块的临床分期,约有40%的患者能达到腋窝淋巴结的病理完全缓解,从而实现了腋窝淋巴结的降期。而对于经过新辅助化疗或化疗联合靶向治疗后经影像学评估达到腋窝淋巴结临床完全缓解的患者,其腋窝淋巴结缓解情况的预测及新辅助化疗后腋窝前哨淋巴结活检等,仍存在诸多争议,成为临床治疗选择上的难题。本文拟对近年来新辅助化疗后腋窝淋巴结处理的相关研究及临床试验进行分析和解读,并对新近开展的临床研究进行梳理,以期为临床提供更多参考信息。     

应用彩色多普勒超声评价乳腺癌新辅助化疗前后的疗效

目的分析乳腺癌术前新辅助化疗前后彩色多普勒的超声特点,探讨超声对其疗效评价的意义.方法分别于化疗前后对56例新辅助化疗的乳腺癌患者的乳腺癌原发灶及腋窝淋巴结进行观察及分析.结果56例患者新辅助化疗后超声检查显示,化疗后原发灶面积明显缩小,原发灶内血流丰富程度降低或消失;Vmax、RI降低(P＜0.01,P＜0.05);47枚异常淋巴结中19枚化疗后消失,有28例淋巴结内可检测出血流信号,化疗后21例血流丰富程度降低.结论乳腺癌新辅助化疗后,原发灶和腋窝淋巴结的大小及彩色多普勒的多项指标发生显著性变化.超声检查为新辅助化疗提供了简便、安全的疗效观察手段.     

乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解列线图预测模型的构建

目的建立乳腺癌新辅助化疗后同侧锁骨上淋巴结病理完全缓解(ispCR)的预测模型, 以指导局部治疗。方法连续纳入2012年9月至2019年5月河南省肿瘤医院收治的首诊同侧锁骨上淋巴结转移且新辅助化疗后行同侧锁骨上淋巴结清扫的乳腺癌患者211例, 分为训练集142例, 验证集69例。采用单因素和多因素logistic回归分析确定乳腺癌新辅助化疗后ispCR的影响因素, 建立乳腺癌新辅助化疗后ispCR的列线图预测模型。通过受试者工作特征(ROC)曲线分析和绘制校准曲线对列线图预测模型进行内部和外部验证评价。结果单因素logistic回归分析显示, Ki-67指数、腋窝淋巴结转移数目、乳腺pCR、腋窝pCR、新辅助化疗后同侧锁骨上淋巴结大小与乳腺癌新辅助化疗后ispCR有关(均P<0.05)。多因素logistic回归分析显示, 腋窝淋巴结转移数目(OR=5.035, 95%CI为1.722～14.721)、乳腺pCR (OR=4.662, 95%CI为1.456～14.922)和新辅助化疗后同侧锁骨上淋巴结大小(OR=4.231, 95%CI为1.194～14.985)是乳腺癌新辅助...     

前哨淋巴结活检在早期乳腺癌患者腋窝管理中的研究进展

传统的观点认为腋窝淋巴结清扫（axillary lymph node dissection,ALND）是前哨淋巴结（sentinel lymph node,SLN）阳性乳腺癌患者的标准治疗方法,而ALND容易引起上肢水肿、功能障碍等术后并发症,影响患者生活质量。近几年研究显示,对于SLN阳性的早期乳腺癌,并非所有患者都需行ALND。对于微转移及1~2枚SLN阳性的早期乳腺癌患者,免除ALND并不影响总体生存。此外,对于临床腋窝淋巴结阳性的乳腺癌患者,经新辅助化疗临床腋窝淋巴结转阴后,行前哨淋巴结活检（sentinel lymph node biopsy,SLNB）能否准确评估腋窝淋巴结状况仍有较多争议。本文将结合乳腺癌腋窝淋巴结管理的相关文献,针对前哨淋巴结阳性的早期乳腺癌腋窝处理策略,以及临床淋巴结阳性的乳腺癌新辅助化疗后行SLNB的可行性进行综述。     

女性乳腺癌患者229例新辅助化疗的影响因素

目的 分析女性乳腺癌患者实施新辅助化疗的临床影响因素,为是否进行新辅助化疗及化疗方案选择提供依据.方法 根据229例女性乳腺癌患者术后雌激素受体(ER)、C-erhB-2、p53蛋白表达状态,分为阳性组和阴性组,对相关临床因素分别进行多因素非条件的Logistic回归分析.结果 月经状况为影响乳腺癌ER表达状态的临床因素;腋窝淋巴结转移、月经状况、乳腺增生史是影响乳腺癌C-erbB-2表达的临床因素;年龄、肿块大小、腋窝淋巴结转移、月经状况是影响乳腺癌p53表达状态的临床因素.结论 月经状况、腋窝淋巴结转移、年龄、肿块大小、乳腺增生史对决定乳腺癌患者是否进行新辅助化疗以及选择何种化疗方案具有一定的指导价值.     

前哨淋巴结活检术在乳腺癌新辅助化疗中的应用进展

前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）主要用于腋窝淋巴结阴性的早期乳腺癌患者,前哨淋巴结阴性者可免除腋窝淋巴结清扫术。但SLNB在非早期乳腺癌患者新辅助化疗过程中的应用是否具有同样的价值,以及如何保证准确率及假阴性率,目前尚无统一共识。本文就SLNB在乳腺癌患者新辅助化疗应用中的研究进展进行综述。     

乳腺癌新辅助化疗后腋窝淋巴结转移综合预测模型的建立

目的:建立乳腺癌新辅助化疗后淋巴结转移的综合预测模型，评估新辅助化疗后淋巴结转移情况，指导临床手术方案选择。方法:回顾分析2015年1月至2018年12月143例乳腺癌新辅助化疗患者的临床、病理及影像资料，并根据术后淋巴结病理分为转移组与无转移组。采用χ2/t检验对两组指标进行单因素分析；将P<0.05的指标纳入多因素Logistic回归分析。用多因素分析有统计学意义(P<0.05)的指标构建乳腺癌新辅助化疗后淋巴结转移综合预测模型的列线图，并应用受试者工作特征（receiver operation characteristic,ROC)曲线评价此模型的性能。结果:单因素分析表明化疗方案、化疗前淋巴结穿刺病理、术前查体、术前彩超、术前CT/MRI、RECIST分级对腋窝淋巴结转移有预测作用；多因素分析表明，化疗前淋巴结穿刺病理、术前彩超、RECIST分级是新辅助化疗后腋窝淋巴结转移的独立预测因素。乳腺癌新辅助化疗后淋巴结转移的预测模型的曲线下面积为0.785，特异度为85.4%，敏感度为59.8%。结论:乳腺癌新辅助化疗后淋巴结转移的综合预测模型对腋窝淋巴结有较好的预测能力，可为选择合适的手术方式提供临床指导。     

Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer.

PURPOSE: Sentinel lymph node (SLN) biopsy has proved to be an accurate method for detecting nodal micrometastases in previously untreated patients with early-stage breast cancer. We investigated the accuracy of this technique for patients with more advanced breast cancer after neoadjuvant chemotherapy. PATIENTS AND METHODS: Patients with stage II or III breast cancer who had undergone doxorubicin-based neoadjuvant chemotherapy before breast surgery were eligible. Intraoperative lymphatic mapping was performed with peritumoral injections of blue dye alone or in combination with technetium-labeled sulfur colloid. All patients were offered axillary lymph node dissection. Negative sentinel and axillary nodes were subjected to additional processing with serial step sectioning and immunohistochemical staining with an anticytokeratin antibody to detect micrometastases. RESULTS: Fifty-one patients underwent SLN biopsy after neoadjuvant chemotherapy from 1994 to 1999. The SLN identification rate improved from 64.7% to 94.1%. Twenty-two (51.2%) of the 43 successfully mapped patients had positive SLNs, and in 10 of those 22 patients (45.5%), the SLN was the only positive node. Three patients had false-negative SLN biopsy; that is, the sentinel node was negative, but at least one nonsentinel node contained metastases. Additional processing revealed occult micrometastases in four patients (three in sentinel nodes and one in a nonsentinel node). CONCLUSION: SLN biopsy is accurate after neoadjuvant chemotherapy. The SLN identification improved with experience. False-negative findings occurred at a low rate throughout the series. This technique is a potential way to guide the axillary treatment of patients who are clinically node negative after neoadjuvant chemotherapy.     

Use of Sentinel Lymph Node Biopsy to Select Patients for Local–Regional Therapy After Neoadjuvant Chemotherapy

Use of sentinel lymph node biopsy for axillary staging of patients with breast cancer treated with neoadjuvant chemotherapy has been widely debated. Questions arise regarding the accuracy of sentinel lymph node biopsy in axillary staging for these patients and its use to determine further local–regional therapy, including surgery and radiation therapy. For patients who are clinically node-negative at presentation, sentinel lymph node biopsy enables accurate staging of the axilla after neoadjuvant chemotherapy, and determination of which patients should go on to further axillary surgery and regional nodal radiation therapy. Importantly, performing axillary staging after completion of chemotherapy, rather than before chemotherapy, enables assessment of response to chemotherapy and the extent of residual disease. This information can assist the planning of adjuvant treatment. Recent data indicate that sentinel node biopsy can also be used to assess disease response after neoadjuvant chemotherapy for patients with clinical N1 disease at presentation.     

Outcome following sentinel lymph node biopsy-guided decisions in breast cancer patients with conversion from positive to negative axillary lymph nodes after neoadjuvant chemotherapy

Purpose

Many breast cancer patients with positive axillary lymph nodes achieve complete node remission after neoadjuvant chemotherapy. The usefulness of sentinel lymph node biopsy in this situation is uncertain. This study evaluated the outcomes of sentinel biopsy-guided decisions in patients who had conversion of axillary nodes from clinically positive to negative following neoadjuvant chemotherapy.

Methods

We reviewed the records of 1247 patients from five hospitals in Korea who had breast cancer with clinically axillary lymph node-positive status and negative conversion after neoadjuvant chemotherapy, between 2005 and 2012. Patients who underwent axillary operations with sentinel biopsy-guided decisions (Group A) were compared with patients who underwent complete axillary lymph node dissection without sentinel lymph node biopsy (Group B). Axillary node recurrence and distant recurrence-free survival were compared.

Results

There were 428 cases in Group A and 819 in Group B. Kaplan–Meier analysis showed that recurrence-free survivals were not significantly different between Groups A and B (4-year axillary recurrence-free survival: 97.8 vs. 99.0%; p = 0.148). Multivariate analysis also indicated the two groups had no significant difference in axillary and distant recurrence-free survival.

Conclusions

For breast cancer patients who had clinical conversion of axillary lymph nodes from positive to negative following neoadjuvant chemotherapy, sentinel biopsy-guided axillary surgery, and axillary lymph node dissection without sentinel lymph node biopsy had similar rates of recurrence. Thus, sentinel biopsy-guided axillary operation in breast cancer patients who have clinically axillary lymph node positive to negative conversion following neoadjuvant chemotherapy is a useful strategy.

     

乳腺癌新辅助化疗后前哨淋巴结活检意义的前瞻性研究

目的:探讨乳腺癌患者新辅助化疗(NAC)后腋窝前哨淋巴结活检的可行性.方法:采用99Tc硫胶体联合亚甲蓝示踪法对60例NAC后达到临床腋淋巴结阴性的乳腺癌患者和60例临床腋淋巴结阴性的早期乳腺癌患者进行腋窝前哨淋巴结活检术(SLNB),评估SLNB的检出率和准确性,比较两组患者SLNB的检出率和假阴性率,并分析NAC后SLNB检出率和假阴性率与患者及肿瘤特点的关系.结果:60例NAC后患者的前哨淋巴结(SLN)检出率为90%,SLNB的敏感度为90%,特异度为93.33%,准确性为91.67%,假阴性率为10%.其检出率和假阴性率与早期乳腺癌组比较,差异均无统计学意义(P=0.743,P=1.000).NAC组化疗前临床分期T3或N2以上者,腋淋巴结的检出率均显著下降,差异有统计学意义(P=0.030,P=0.000),分期N2以上者假阴性率显著增高,差异有统计学意义,P=0.001.结论:对NAC后达到临床淋巴结阴性的乳腺癌患者,腋窝SLN的检出率和假阴性率与早期乳腺癌SLNB差异无统计学意义,化疗前的TN分期是SLNB检出率和假阴性影响因素.     

Feasibility of targeted axillary dissection for de-escalation of surgical treatment after neoadjuvant chemotherapy in breast cancer

BackgroundTargeted axillary dissection, which combines sentinel lymph node biopsy with removal of the proven involved node noted during the staging process, has been shown to improve axillary staging and decrease false negative rates after neoadjuvant chemotherapy in patients with breast cancer.Objective(s)The main goal of this study was to assess the ability to identify and remove the clipped node and the false negative rate of targeted axillary dissection.MethodsWe performed a prospective study among patients with biopsy-confirmed nodal metastases who received neoadjuvant chemotherapy. A clip was placed on the sample node prior systemic therapy. After neoadjuvant chemotherapy, all patients underwent sentinel lymph node biopsy (dual tracer), localization and excision of the clipped node and axillary lymph node dissection. The clipped node was preoperatively localized in all cases placing an iodine-125 seed guided by ultrasound. The pathology of the sentinel nodes and clipped node was compared with other nodes.ResultsA total of 455 patients with invasive breast cancer were studied. Of the 148 patients with NAC, 32 met the eligibility criteria and were enrolled in the study. Mean age at diagnosis was 52.3 years. Systematic lymphadenectomy was performed in all patients, with an average of 14.3 lymph nodes removed. Detection rate of the clipped node alone was 96.9%, and 100% for targeted axillary dissection. Ability of clipped node alone to predict nodal status showed a FNR of 10,5% while SLNB alone performed by dual tracer and targeted axillary dissection, showed FNRs of 5.3% and 5.0%, respectively. Sentinel lymph nodes matched clipped node in 23 patients (74.2%).Conclusion (s)In node positive breast cancer patients, targeted axillary dissection is a reliably approach for axillary staging after neoadjuvant chemotherapy. The preoperative location of the clipped node is mandatory to increase the detection rate and optimize the results of the technique.     

乳腺癌前哨淋巴结活检研究进展

近年来,乳腺癌的发病率越来越高,乳腺癌治疗方式也在不断改进,但手术仍然是早期乳腺癌治疗的主要手段。对于早期乳腺癌,前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）是一种安全、精确的手术方式,已逐渐替代腋窝淋巴结清扫术（axillary lymph node dissection,ALND）成为早期乳腺癌治疗的标准术式。随着研究的深入,SLNB的应用范围更广,术后生活质量显著改善,但其操作尚需要进一步统一规范。在前哨淋巴结微转移、宏转移、前哨淋巴结活检阳性的老年患者以及新辅助化疗的前哨淋巴结活检等方面尚未达成共识,还需要更多大型多中心前瞻性的随机试验来进一步论证。     

Aflibercept—a Decoy VEGF Receptor

Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer and is a reasonable alternative to adjuvant chemotherapy for those with large operable disease. Potential clinical advantages of neoadjuvant chemotherapy include the conversion of some patients requiring mastectomy to candidates for breast-conserving surgery, the potential for downstaging axillary nodes and thus reducing the extent of axillary surgery, and the ability to correlate clinical and pathologic response to neoadjuvant chemotherapy with improved long-term outcomes. An important and controversial locoregional therapy issue in patients who are candidates for neoadjuvant chemotherapy relates to the timing of sentinel lymph node biopsy – i.e., either before or after neoadjuvant chemotherapy. This review will focus on the performance characteristics of sentinel lymph node biopsy before vs. after neoadjuvant chemotherapy and on the pros and cons of each approach.