低负荷前哨淋巴结阳性早期乳腺癌患者腋窝处理策略

摘要

前哨淋巴结阳性患者的常规处理是进一步行腋窝淋巴结清扫,但腋窝淋巴结清扫会带来血清肿、上肢功能障碍、水肿等并发症.Z0011、IBCSG 23-01和AMAROS的Ⅲ期随机对照临床研究探索均为在临床N0期患者中安全减免前哨淋巴结活检阳性后的腋窝淋巴结清扫,为这部分患者的腋窝处理提供了新选择,但也给辅助放疗决策带来了新问题.本文将主要基于上述三项临床研究和腋窝淋巴结转移复发风险相关最新文献,针对包括手术和辅助放疗在内的低负荷前哨淋巴结阳性患者腋窝处理策略进行综述.%For patients with positive sentinel lymph nodes, axillary lymph node dissection ( ALND) is the conventional treatment. However, ALND can cause seroma, the upper limb dysfunction, edema and alternative complications. Z0011, IBCSG 23-01 and AMAROS phaseⅢrandomized controlled clinical trials recommend ALND after sentinel lymph node biopsy in N0 patients, which provides a novel option for axillary lymph node treatment, but also brings new challenges to the decision of adjuvant radiotherapy. In this paper, based upon these three clinical trials and latest literatures related to the risk of axillary lymph node metastasis and recurrence, the therapeutic strategies including surgery and adjuvant radiotherapy for patients with positive sentinel lymph nodes are reviewed and summarized.