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Article(id=1198196212106101368, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198196207379120715, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1155.2024.0418, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1693411200000, receivedDateStr=2023-08-31, revisedDate=null, revisedDateStr=null, acceptedDate=1698768000000, acceptedDateStr=2023-11-01, onlineDate=1763601838375, onlineDateStr=2025-11-20, pubDate=1735315200000, pubDateStr=2024-12-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763601838375, onlineIssueDateStr=2025-11-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763601838375, creator=13701087609, updateTime=1763601838375, updator=13701087609, issue=Issue{id=1198196207379120715, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='12', pageStart='1343', pageEnd='1459', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763601837248, creator=13701087609, updateTime=1763603898104, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198204851306988030, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198196207379120715, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198204851306988031, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198196207379120715, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1394, endPage=1399, ext={EN=ArticleExt(id=1198196212345176701, articleId=1198196212106101368, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical analysis of the ACOSOG Z0011 trial applied to young breast cancer, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate whether axillary lymph node dissection (ALND) can be exempted for young breast cancers with reference to the inclusion criteria of American College of Surgeons Oncology Group (ACOSOG) Z0011 trial. Methods A retrospective analysis was conducted on 134 cases of young breast cancer patients admitted to the Second Affiliated Hospital of Nanchang University and the Affiliated Hospital of Jiujiang College from February 28, 2013 to February 28, 2018 who met the inclusion criteria of the ACOSOG Z0011 trial. Patients were divided into case group [n=63, with sentinel lymph node biopsy (SLNB)] and control group (n=71, with SLNB and ALND). General clinicopathologic data, including age, tumor TNM stage, pregnancy or breastfeeding status, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, vessel carcinoma embolus, and tumor Nottingham grade, were collected and compared between the two groups. The 5-year disease-free survival (DFS) and 5-year overall survival (OS) of the two groups were analyzed using the Kaplan-Meier method with log-rank tests. A multifactorial Cox proportional hazards regression model was used to analyze the effect of SLNB implementation alone on the DFS and OS in young breast cancer. Results There were no statistically significant differences in age, pregnancy or breastfeeding status, tumor T classification, tumour molecular classification, tumor Nottingham grade and vessel carcinoma embolus between the two groups (P>0.05). The 5-year DFS rate for the 134 young breast cancer patients was 74.6% and the 5-year OS rate was 83.6%. A statistically significant difference was observed in the 5-year DSF rate between case and control groups (66.7% vs. 81.7%, P=0.033), while there was no statistically significant difference in the 5-year OS rate (77.8% vs. 88.7%, P=0.085). The multifactorial Cox proportional hazards regression model analysis showed that performing SLNB alone was an independent risk factor for DFS in young breast cancer patients (HR=2.261, 95%CI 1.097-4.660, P=0.027), but not for OS (HR=1.976, 95%CI 0.789-4.946, P=0.146). Conclusions Young breast cancers exempted from ALND according to the ACOSOG Z0011 trial inclusion criteria had a higher rate of local recurrence, but their OS was not significant affected. Therefore, whether young breast cancers can be exempted from ALND still requires further clinical trial validation.

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目的 探讨年轻乳腺癌患者可否参照美国外科医师协会肿瘤学组(ACOSOG) Z0011试验入组标准豁免腋窝淋巴结清扫(ALND)。方法 收集2013年2月28日－2018年2月28日南昌大学第二附属医院及九江学院第二附属医院收治的符合ACOSOG Z0011试验入组标准的134例年轻乳腺癌患者为研究对象，根据手术方式不同分为病例组[n=63，仅行前哨淋巴结活检(SLNB)]与对照组(n=71，行SLNB+ALND)。收集并比较两组患者的一般临床病理资料[年龄、肿瘤TNM分期、是否妊娠或哺乳期、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、Ki-67、脉管内癌栓、肿瘤Nottingham分级]，采用Kaplan-Meier法对两组患者的5年无病生存期(DFS)及5年总生存期(OS)进行分析并进行log-rank检验，采用多因素Cox比例风险回归模型分析仅行SLNB对年轻乳腺癌DFS及OS的影响。结果 两组年龄、妊娠或哺乳状态、肿瘤T分期、肿瘤分子分型、肿瘤Nottingham分级及脉管内癌栓等差异均无统计学意义(P>0.05)。134例年轻乳腺癌患者的5年DFS率为74.6%，5年OS率为83.6%。病例组与对照组5年DSF率差异有统计学意义(66.7% vs. 81.7%，P=0.033)，5年OS率差异无统计学意义(77.8% vs. 88.7%，P=0.085)。多因素Cox比例风险回归模型分析结果显示，仅行SLNB是年轻乳腺癌患者DFS的独立危险因素(HR=2.261，95%CI 1.097~4.660，P=0.027)，但不是OS的独立危险因素(HR=1.976，95%CI 0.789~4.946，P=0.146)。结论 年轻乳腺癌按照ACOSOG Z0011试验入组标准豁免ALND具有较高的局部复发率，但OS无明显影响，因此，年轻乳腺癌患者是否可豁免ALND仍需进一步的临床试验加以验证。

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夏坤健，硕士研究生，主要从事乳腺癌的基础与临床研究

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夏坤健，硕士研究生，主要从事乳腺癌的基础与临床研究

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夏坤健，硕士研究生，主要从事乳腺癌的基础与临床研究

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Nakagawa T, Mori H, journalName=World J Clin Oncol, refType=null, unstructuredReference=Oda G, Nakagawa T, Mori H, et al. Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients[J]. World J Clin Oncol, 2022, 13(9): 748-757., articleTitle=Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients, refAbstract=null), Reference(id=1198318896177578483, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2023, volume=174, issue=2, pageStart=416, pageEnd=418, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=Giannakou A, Gooch J, Gergelis KR, journalName=Surgery, refType=null, unstructuredReference=Giannakou A, Gooch J, Gergelis KR, et al. De-escalation of axillary surgery in patients outside Z0011 criteria[J]. Surgery, 2023, 174(2): 416-418., articleTitle=De-escalation of axillary surgery in patients outside Z0011 criteria, refAbstract=null), Reference(id=1198318896303407610, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=6, pageStart=691, pageEnd=722, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Gradishar WJ, Moran MS, Abraham J, journalName=J Natl Compr Canc Netw, refType=null, unstructuredReference=Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(6): 691-722., articleTitle=Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology, refAbstract=null), Reference(id=1198318896378905082, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2016, volume=264, issue=3, pageStart=413, pageEnd=420, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Giuliano AE, Ballman K, McCall L, journalName=Ann Surg, refType=null, unstructuredReference=Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial[J]. Ann Surg, 2016, 264(3): 413-420., articleTitle=Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial, refAbstract=null), Reference(id=1198318896483762686, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2011, volume=18, issue=9, pageStart=2407, pageEnd=2412, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=Caudle AS, Hunt KK, Kuerer HM, journalName=Ann Surg Oncol, refType=null, unstructuredReference=Caudle AS, Hunt KK, Kuerer HM, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial[J]. Ann Surg Oncol, 2011, 18(9): 2407-2412., articleTitle=Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial, refAbstract=null), Reference(id=1198318896613786115, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=47, issue=10, pageStart=2499, pageEnd=2505, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=Mattar D, di Filippo A, Invento A, journalName=Eur J Surg Oncol, refType=null, unstructuredReference=Mattar D, di Filippo A, Invento A, et al. Economic implications of ACOSOG Z0011 trial application into clinical practice at the European Institute of Oncology[J]. Eur J Surg Oncol, 2021, 47(10): 2499-2505., articleTitle=Economic implications of ACOSOG Z0011 trial application into clinical practice at the European Institute of Oncology, refAbstract=null), Reference(id=1198318896714449417, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=13, issue=9, pageStart=2150, pageEnd=null, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=Nguyen DV, Kim SW, Oh YT, journalName=Cancers (Basel), refType=null, unstructuredReference=Nguyen DV, Kim SW, Oh YT, et al. Local recurrence in young women with breast cancer: breast conserving therapy vs. mastectomy alone[J]. Cancers (Basel), 2021, 13(9): 2150., articleTitle=Local recurrence in young women with breast cancer: breast conserving therapy vs. mastectomy alone, refAbstract=null), Reference(id=1198318896840278539, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2015, volume=5, issue=null, pageStart=15241, pageEnd=null, url=null, language=null, rfNumber=[8], rfOrder=7, authorNames=Liu M, Wang S, Cui S, journalName=Sci Rep, refType=null, unstructuredReference=Liu M, Wang S, Cui S, et al. The feasibility of the ACOSOG Z0011 criteria to Chinese breast cancer patients: a multicenter study[J]. Sci Rep, 2015, 5: 15241., articleTitle=The feasibility of the ACOSOG Z0011 criteria to Chinese breast cancer patients: a multicenter study, refAbstract=null), Reference(id=1198318896949330452, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2022, volume=33, issue=11, pageStart=1097, pageEnd=1118, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=Paluch-Shimon S, Cardoso F, Partridge AH, journalName=Ann Oncol, refType=null, unstructuredReference=Paluch-Shimon S, Cardoso F, Partridge AH, et al. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5)[J]. Ann Oncol, 2022, 33(11): 1097-1118., articleTitle=ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5), refAbstract=null), Reference(id=1198318897054188057, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2016, volume=23, issue=3, pageStart=367, pageEnd=377, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=Jinno H, Inokuchi M, Ito T, journalName=Breast Cancer, refType=null, unstructuredReference=Jinno H, Inokuchi M, Ito T, et al. The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition[J]. Breast Cancer, 2016, 23(3): 367-377., articleTitle=The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition, refAbstract=null), Reference(id=1198318897159045660, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2017, volume=15, issue=4, pageStart=433, pageEnd=451, url=null, language=null, rfNumber=[11], rfOrder=10, authorNames=Gradishar WJ, Anderson BO, Balassanian R, journalName=J Natl Compr Canc Netw, refType=null, unstructuredReference=Gradishar WJ, Anderson BO, Balassanian R, et al. NCCN guidelines insights: breast cancer, version 1.2017[J]. J Natl Compr Canc Netw, 2017, 15(4): 433-451., articleTitle=NCCN guidelines insights: breast cancer, version 1.2017, refAbstract=null), Reference(id=1198318897284874785, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2004, volume=91, issue=1, pageStart=38, pageEnd=43, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=Tominaga T, Takashima S, Danno M, journalName=Br J Surg, refType=null, unstructuredReference=Tominaga T, Takashima S, Danno M. Randomized clinical trial comparing level Ⅱ and level Ⅲ axillary node dissection in addition to mastectomy for breast cancer[J]. Br J Surg, 2004, 91(1): 38-43., articleTitle=Randomized clinical trial comparing level Ⅱ and level Ⅲ axillary node dissection in addition to mastectomy for breast cancer, refAbstract=null), Reference(id=1198318897398120999, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2020, volume=24, issue=null, pageStart=100182, pageEnd=null, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Co M, Kwong A, journalName=Cancer Treat Res Commun, refType=null, unstructuredReference=Co M, Kwong A. Young onset breast cancer in Southern China - a 5-year clinico-pathological study from a multi-centre database[J]. Cancer Treat Res Commun, 2020, 24: 100182., articleTitle=Young onset breast cancer in Southern China - a 5-year clinico-pathological study from a multi-centre database, refAbstract=null), Reference(id=1198318897486201389, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2023, volume=307, issue=3, pageStart=957, pageEnd=968, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=Wang W, Tian B, Xu X, journalName=Arch Gynecol Obstet, refType=null, unstructuredReference=Wang W, Tian B, Xu X, et al. Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study[J]. Arch Gynecol Obstet, 2023, 307(3): 957-968., articleTitle=Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study, refAbstract=null), Reference(id=1198318897595253296, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=5, issue=1, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=André C, Holsti C, Svenner A, journalName=BJS Open, refType=null, unstructuredReference=André C, Holsti C, Svenner A, et al. Recurrence and survival after standard versus oncoplastic breast-conserving surgery for breast cancer[J]. BJS Open, 2021, 5(1): zraa013., articleTitle=Recurrence and survival after standard versus oncoplastic breast-conserving surgery for breast cancer, refAbstract=null), Reference(id=1198318897679139382, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2017, volume=24, issue=12, pageStart=3559, pageEnd=3566, url=null, language=null, rfNumber=[16], rfOrder=15, authorNames=Ong CT, Thomas SM, Blitzblau RC, journalName=Ann Surg Oncol, refType=null, unstructuredReference=Ong CT, Thomas SM, Blitzblau RC, et al. Patient age and tumor subtype predict the extent of axillary surgery among breast cancer patients eligible for the American College of Surgeons Oncology Group trial Z0011[J]. Ann Surg Oncol, 2017, 24(12): 3559-3566., articleTitle=Patient age and tumor subtype predict the extent of axillary surgery among breast cancer patients eligible for the American College of Surgeons Oncology Group trial Z0011, refAbstract=null), Reference(id=1198318897792385592, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2019, volume=173, issue=2, pageStart=429, pageEnd=438, url=null, language=null, rfNumber=[17], rfOrder=16, authorNames=Hennigs A, Köpke M, Feißt M, journalName=Breast Cancer Res Treat, refType=null, unstructuredReference=Hennigs A, Köpke M, Feißt M, et al. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice?[J]. Breast Cancer Res Treat, 2019, 173(2): 429-438., articleTitle=Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice?, refAbstract=null), Reference(id=1198318897897243197, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=43, issue=4, pageStart=297, pageEnd=303, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=Shinzato JY, Serra KP, Eugeni C, journalName=Rev Bras Ginecol Obstet, refType=null, unstructuredReference=Shinzato JY, Serra KP, Eugeni C, et al. Potential impact of the Z0011 trial on the omission of axillary dissection: a retrospective cohort study[J]. Rev Bras Ginecol Obstet, 2021, 43(4): 297-303., articleTitle=Potential impact of the Z0011 trial on the omission of axillary dissection: a retrospective cohort study, refAbstract=null), Reference(id=1198318897993712195, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2014, volume=21, issue=1, pageStart=22, pageEnd=27, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=Dengel LT, van Zee KJ, King TA, journalName=Ann Surg Oncol, refType=null, unstructuredReference=Dengel LT, van Zee KJ, King TA, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy[J]. Ann Surg Oncol, 2014, 21(1): 22-27., articleTitle=Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy, refAbstract=null), Reference(id=1198318898102764102, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=19, issue=1, pageStart=128, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=19, authorNames=Peng Y, Liu M, Li X, journalName=World J Surg Oncol, refType=null, unstructuredReference=Peng Y, Liu M, Li X, et al. Application of the ACOSOG Z0011 criteria to Chinese patients with breast cancer: a prospective study[J]. World J Surg Oncol, 2021, 19(1): 128., articleTitle=Application of the ACOSOG Z0011 criteria to Chinese patients with breast cancer: a prospective study, refAbstract=null), Reference(id=1198318898211816010, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2018, volume=9, issue=1, pageStart=10, pageEnd=18, url=null, language=null, rfNumber=[21], rfOrder=20, authorNames=Li S, Wang X, Yang J, journalName=Thorac Cancer, refType=null, unstructuredReference=Li S, Wang X, Yang J, et al. Clinicopathological features and survival of early stage breast cancer in Northwest China: a population-based retrospective study of 1287 patients[J]. Thorac Cancer, 2018, 9(1): 10-18., articleTitle=Clinicopathological features and survival of early stage breast cancer in Northwest China: a population-based retrospective study of 1287 patients, refAbstract=null), Reference(id=1198318898316673614, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2014, volume=21, issue=6, pageStart=643, pageEnd=650, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=Kataoka A, Tokunaga E, Masuda N, journalName=Breast Cancer, refType=null, unstructuredReference=Kataoka A, Tokunaga E, Masuda N, et al. Clinicopathological features of young patients (<35 years of age) with breast cancer in a Japanese Breast Cancer Society supported study[J]. Breast Cancer, 2014, 21(6): 643-650., articleTitle=Clinicopathological features of young patients (<35 years of age) with breast cancer in a Japanese Breast Cancer Society supported study, refAbstract=null), Reference(id=1198318898404754002, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=221, issue=4, pageStart=809, pageEnd=812, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Macfie R, Aks C, Panwala K, journalName=Am J Surg, refType=null, unstructuredReference=Macfie R, Aks C, Panwala K, et al. Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage Ⅱ triple negative breast cancer[J]. Am J Surg, 2021, 221(4): 809-812., articleTitle=Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage Ⅱ triple negative breast cancer, refAbstract=null), Reference(id=1198318898471862871, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2021, volume=21, issue=1, pageStart=107, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Yang Q, Zhong X, Zhang W, journalName=BMC Cancer, refType=null, unstructuredReference=Yang Q, Zhong X, Zhang W, et al. Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China[J]. BMC Cancer, 2021, 21(1): 107., articleTitle=Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China, refAbstract=null), Reference(id=1198318898534777435, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2014, volume=32, issue=32, pageStart=3600, pageEnd=3606, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Jagsi R, Chadha M, Moni J, journalName=J Clin Oncol, refType=null, unstructuredReference=Jagsi R, Chadha M, Moni J, et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial[J]. J Clin Oncol, 2014, 32(32): 3600-3606., articleTitle=Radiation field design in the ACOSOG Z0011 (Alliance) Trial, refAbstract=null), Reference(id=1198318898664800863, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2017, volume=318, issue=10, pageStart=909, pageEnd=911, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=Livingston EH, Li HC, journalName=JAMA, refType=null, unstructuredReference=Livingston EH, Li HC. Breast cancer surgery: less is more[J]. JAMA, 2017, 318(10): 909-911., articleTitle=Breast cancer surgery: less is more, refAbstract=null), Reference(id=1198318898757075556, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, doi=null, pmid=null, pmcid=null, year=2017, volume=318, issue=10, pageStart=918, pageEnd=926, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=Giuliano AE, Ballman KV, McCall L, journalName=JAMA, refType=null, unstructuredReference=Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial[J]. JAMA, 2017, 318(10): 918-926., articleTitle=Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1198318891991662876, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, xref=1, ext=[AuthorCompanyExt(id=1198318892000051485, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, companyId=1198318891991662876, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of General Surgery, the Second Affiliated Hospital of Jiujiang College, Jiujiang, Jiangxi 332005, China), AuthorCompanyExt(id=1198318892008440094, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, companyId=1198318891991662876, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1九江学院第二附属医院普通外科，江西九江 332005)]), AuthorCompany(id=1198318892092326183, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, xref=2, ext=[AuthorCompanyExt(id=1198318892100714792, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, companyId=1198318892092326183, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Breast Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China), AuthorCompanyExt(id=1198318892109103401, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, companyId=1198318892092326183, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2南昌大学第二附属医院乳腺外科，江西南昌 330006)])], figs=[ArticleFig(id=1198318894063649199, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=EN, label=Fig.1, caption=Screening process of breast cancer patients, figureFileSmall=0engx7GkTPzhpmboMnmAdw==, figureFileBig=WYpPT7A9/O+iQpYz4b3MKQ==, tableContent=null), ArticleFig(id=1198318894155923894, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=CN, label=图1, caption=乳腺癌患者筛选流程

SLNB. 前哨淋巴结活检；ALMD. 腋窝淋巴结清扫

, figureFileSmall=0engx7GkTPzhpmboMnmAdw==, figureFileBig=WYpPT7A9/O+iQpYz4b3MKQ==, tableContent=null), ArticleFig(id=1198318894285947327, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=EN, label=Fig.2, caption=Comparison of the survival rate between two groups of breast cancer patients, figureFileSmall=nxZtnAAfrkrLkMmqdQ1gEg==, figureFileBig=N4DzAB4c/asE/B3oI56XwA==, tableContent=null), ArticleFig(id=1198318894378222021, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=CN, label=图2, caption=两组年轻乳腺癌患者生存率比较

DFS. 无病生存期；OS. 总生存期

, figureFileSmall=nxZtnAAfrkrLkMmqdQ1gEg==, figureFileBig=N4DzAB4c/asE/B3oI56XwA==, tableContent=null), ArticleFig(id=1198318894491468238, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=EN, label=Tab.1, caption=

Comparison of general clinical pathological data between two groups of breast cancer patients

, figureFileSmall=null, figureFileBig=null, tableContent=
临床病理特征 对照组(n=71) 病例组(n=63) Z/χ2 P
年龄[岁, M(Q1,Q3)] 35.0(32.0, 39.0) 34.0(29.0, 39.0) -0.768 0.442
妊娠期或哺乳期[例(%)] 0.266 0.606
否 61(85.9) 56(88.9)
是 10(14.1) 7(11.1)
肿瘤T分期[例(%)] 0.867 0.352
T1 36(50.7) 37(58.7)
T2 35(49.3) 26(41.3)
ALN
有转移 7(9.9) 未明确
无转移 64(90.1)
ER[例(%)] 1.211 0.271
阴性 48(67.6) 48(76.2)
阳性 23(32.4) 15(23.8)
PR[例(%)] 0.094 0.759
阴性 60(84.5) 52(82.5)
阳性 11(15.5) 11(17.5)
HER2[例(%)] 0.042 0.838
阴性 45(63.4) 41(65.1)
阳性 26(36.6) 22(34.9)
肿瘤分子分型[例(%)] 2.949 0.400
Luminal A型 14(19.7) 6(9.5)
Luminal B型 20(28.2) 20(31.7)
HER2型 19(26.8) 17(27.0)
三阴型 18(25.4) 20(31.7)
脉管内癌栓[例(%)] 1.635 0.201
无 35(49.3) 38(60.3)
有 36(50.7) 25(39.7)
肿瘤Nottingham分级[例(%)] 1.346 0.510
Ⅰ级 6(8.5) 9(14.3)
Ⅱ级 31(43.7) 28(44.4)
Ⅲ级 34(47.9) 26(41.3)
), ArticleFig(id=1198318894596325842, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=CN, label=表1, caption=

两组年轻乳腺癌患者临床病理资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
临床病理特征 对照组(n=71) 病例组(n=63) Z/χ2 P
年龄[岁, M(Q1,Q3)] 35.0(32.0, 39.0) 34.0(29.0, 39.0) -0.768 0.442
妊娠期或哺乳期[例(%)] 0.266 0.606
否 61(85.9) 56(88.9)
是 10(14.1) 7(11.1)
肿瘤T分期[例(%)] 0.867 0.352
T1 36(50.7) 37(58.7)
T2 35(49.3) 26(41.3)
ALN
有转移 7(9.9) 未明确
无转移 64(90.1)
ER[例(%)] 1.211 0.271
阴性 48(67.6) 48(76.2)
阳性 23(32.4) 15(23.8)
PR[例(%)] 0.094 0.759
阴性 60(84.5) 52(82.5)
阳性 11(15.5) 11(17.5)
HER2[例(%)] 0.042 0.838
阴性 45(63.4) 41(65.1)
阳性 26(36.6) 22(34.9)
肿瘤分子分型[例(%)] 2.949 0.400
Luminal A型 14(19.7) 6(9.5)
Luminal B型 20(28.2) 20(31.7)
HER2型 19(26.8) 17(27.0)
三阴型 18(25.4) 20(31.7)
脉管内癌栓[例(%)] 1.635 0.201
无 35(49.3) 38(60.3)
有 36(50.7) 25(39.7)
肿瘤Nottingham分级[例(%)] 1.346 0.510
Ⅰ级 6(8.5) 9(14.3)
Ⅱ级 31(43.7) 28(44.4)
Ⅲ级 34(47.9) 26(41.3)
), ArticleFig(id=1198318894680211928, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=EN, label=Tab.2, caption=

Cox proportional hazards regression analysis of DFS and OS in young breast cancer patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 DFS OS
HR (95%CI) P HR (95%CI) P
年龄 1.022(0.942~1.108) 0.604 1.012(0.912~1.122) 0.824
妊娠期或哺乳期
否 1(参考值) 1(参考值)
是 2.298(0.877~6.021) 0.090 1.982(0.611~6.432) 0.255
肿瘤T分期
T1 1(参考值) 1(参考值)
T2 1.563(0.768~3.181) 0.218 1.471(0.597~3.627) 0.401
肿瘤分子分型
Luminal A型 1(参考值) 1(参考值)
Luminal B型 2.908(0.556~15.202) 0.206 1.348(0.114~15.969) 0.813
HER2型 2.989(0.611~14.632) 0.177 2.760(0.301~25.283) 0.369
三阴型 5.310(1.171~24.071) 0.030 8.946(1.140~70.192) 0.037
脉管内癌栓
无 1(参考值) 1(参考值)
有 1.591(0.793~3.194) 0.191 1.629(0.681~3.897) 0.272
肿瘤Nottingham分级
Ⅰ级 1(参考值) 1(参考值)
Ⅱ级 2.388(0.296~19.287) 0.414 1.016(0.108~9.546) 0.989
Ⅲ级 7.917(1.036~60.522) 0.046 3.898(0.492~30.897) 0.198
治疗方法
SLNB+ALND 1(参考值) 1(参考值)
SLNB 2.403(1.171~4.932) 0.017 2.134(0.854~5.333) 0.105
), ArticleFig(id=1198318895808479713, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198196212106101368, language=CN, label=表2, caption=

年轻乳腺癌患者DFS及OS的Cox比例风险回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 DFS OS
HR (95%CI) P HR (95%CI) P
年龄 1.022(0.942~1.108) 0.604 1.012(0.912~1.122) 0.824
妊娠期或哺乳期
否 1(参考值) 1(参考值)
是 2.298(0.877~6.021) 0.090 1.982(0.611~6.432) 0.255
肿瘤T分期
T1 1(参考值) 1(参考值)
T2 1.563(0.768~3.181) 0.218 1.471(0.597~3.627) 0.401
肿瘤分子分型
Luminal A型 1(参考值) 1(参考值)
Luminal B型 2.908(0.556~15.202) 0.206 1.348(0.114~15.969) 0.813
HER2型 2.989(0.611~14.632) 0.177 2.760(0.301~25.283) 0.369
三阴型 5.310(1.171~24.071) 0.030 8.946(1.140~70.192) 0.037
脉管内癌栓
无 1(参考值) 1(参考值)
有 1.591(0.793~3.194) 0.191 1.629(0.681~3.897) 0.272
肿瘤Nottingham分级
Ⅰ级 1(参考值) 1(参考值)
Ⅱ级 2.388(0.296~19.287) 0.414 1.016(0.108~9.546) 0.989
Ⅲ级 7.917(1.036~60.522) 0.046 3.898(0.492~30.897) 0.198
治疗方法
SLNB+ALND 1(参考值) 1(参考值)
SLNB 2.403(1.171~4.932) 0.017 2.134(0.854~5.333) 0.105
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ACOSOG Z0011试验结论对年轻乳腺癌患者的适用性分析
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夏坤健 1 , 王琳 2 , 唐娜 1
解放军医学杂志 | 临床研究 2024,49(12): 1394-1399
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解放军医学杂志 | 临床研究 2024, 49(12): 1394-1399
ACOSOG Z0011试验结论对年轻乳腺癌患者的适用性分析
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夏坤健1, 王琳2, 唐娜1
作者信息
  • 1九江学院第二附属医院普通外科，江西九江 332005
  • 2南昌大学第二附属医院乳腺外科，江西南昌 330006

    • 夏坤健，硕士研究生，主要从事乳腺癌的基础与临床研究

Clinical analysis of the ACOSOG Z0011 trial applied to young breast cancer
Kun-Jian Xia1, Lin Wang2, Na Tang1
Affiliations
  • 1Department of General Surgery, the Second Affiliated Hospital of Jiujiang College, Jiujiang, Jiangxi 332005, China
  • 2Department of Breast Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
出版时间: 2024-12-28 doi: 10.11855/j.issn.0577-7402.1155.2024.0418
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摘要
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目的 探讨年轻乳腺癌患者可否参照美国外科医师协会肿瘤学组(ACOSOG) Z0011试验入组标准豁免腋窝淋巴结清扫(ALND)。方法 收集2013年2月28日－2018年2月28日南昌大学第二附属医院及九江学院第二附属医院收治的符合ACOSOG Z0011试验入组标准的134例年轻乳腺癌患者为研究对象，根据手术方式不同分为病例组[n=63，仅行前哨淋巴结活检(SLNB)]与对照组(n=71，行SLNB+ALND)。收集并比较两组患者的一般临床病理资料[年龄、肿瘤TNM分期、是否妊娠或哺乳期、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、Ki-67、脉管内癌栓、肿瘤Nottingham分级]，采用Kaplan-Meier法对两组患者的5年无病生存期(DFS)及5年总生存期(OS)进行分析并进行log-rank检验，采用多因素Cox比例风险回归模型分析仅行SLNB对年轻乳腺癌DFS及OS的影响。结果 两组年龄、妊娠或哺乳状态、肿瘤T分期、肿瘤分子分型、肿瘤Nottingham分级及脉管内癌栓等差异均无统计学意义(P>0.05)。134例年轻乳腺癌患者的5年DFS率为74.6%，5年OS率为83.6%。病例组与对照组5年DSF率差异有统计学意义(66.7% vs. 81.7%，P=0.033)，5年OS率差异无统计学意义(77.8% vs. 88.7%，P=0.085)。多因素Cox比例风险回归模型分析结果显示，仅行SLNB是年轻乳腺癌患者DFS的独立危险因素(HR=2.261，95%CI 1.097~4.660，P=0.027)，但不是OS的独立危险因素(HR=1.976，95%CI 0.789~4.946，P=0.146)。结论 年轻乳腺癌按照ACOSOG Z0011试验入组标准豁免ALND具有较高的局部复发率，但OS无明显影响，因此，年轻乳腺癌患者是否可豁免ALND仍需进一步的临床试验加以验证。

年轻乳腺癌  /  ACOSOG Z0011试验  /  无病生存率  /  总生存率

Objective To investigate whether axillary lymph node dissection (ALND) can be exempted for young breast cancers with reference to the inclusion criteria of American College of Surgeons Oncology Group (ACOSOG) Z0011 trial. Methods A retrospective analysis was conducted on 134 cases of young breast cancer patients admitted to the Second Affiliated Hospital of Nanchang University and the Affiliated Hospital of Jiujiang College from February 28, 2013 to February 28, 2018 who met the inclusion criteria of the ACOSOG Z0011 trial. Patients were divided into case group [n=63, with sentinel lymph node biopsy (SLNB)] and control group (n=71, with SLNB and ALND). General clinicopathologic data, including age, tumor TNM stage, pregnancy or breastfeeding status, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, vessel carcinoma embolus, and tumor Nottingham grade, were collected and compared between the two groups. The 5-year disease-free survival (DFS) and 5-year overall survival (OS) of the two groups were analyzed using the Kaplan-Meier method with log-rank tests. A multifactorial Cox proportional hazards regression model was used to analyze the effect of SLNB implementation alone on the DFS and OS in young breast cancer. Results There were no statistically significant differences in age, pregnancy or breastfeeding status, tumor T classification, tumour molecular classification, tumor Nottingham grade and vessel carcinoma embolus between the two groups (P>0.05). The 5-year DFS rate for the 134 young breast cancer patients was 74.6% and the 5-year OS rate was 83.6%. A statistically significant difference was observed in the 5-year DSF rate between case and control groups (66.7% vs. 81.7%, P=0.033), while there was no statistically significant difference in the 5-year OS rate (77.8% vs. 88.7%, P=0.085). The multifactorial Cox proportional hazards regression model analysis showed that performing SLNB alone was an independent risk factor for DFS in young breast cancer patients (HR=2.261, 95%CI 1.097-4.660, P=0.027), but not for OS (HR=1.976, 95%CI 0.789-4.946, P=0.146). Conclusions Young breast cancers exempted from ALND according to the ACOSOG Z0011 trial inclusion criteria had a higher rate of local recurrence, but their OS was not significant affected. Therefore, whether young breast cancers can be exempted from ALND still requires further clinical trial validation.

young breast cancer  /  ACOSOG Z0011 trial  /  disease-free survival  /  overall survival
夏坤健, 王琳, 唐娜. ACOSOG Z0011试验结论对年轻乳腺癌患者的适用性分析. 解放军医学杂志, 2024 , 49 (12) : 1394 -1399 . DOI: 10.11855/j.issn.0577-7402.1155.2024.0418
Kun-Jian Xia, Lin Wang, Na Tang. Clinical analysis of the ACOSOG Z0011 trial applied to young breast cancer[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (12) : 1394 -1399 . DOI: 10.11855/j.issn.0577-7402.1155.2024.0418
正文
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腋窝淋巴结清扫(axillary lymph node dissection，ALND)一直是前哨淋巴结(sentinel lymphnode，SLN)阳性乳腺癌患者的标准治疗手段[1]。然而，美国外科医师协会肿瘤学组(American College of Surgeons Oncology Group，ACOSOG) Z0011试验研究显示，对于临床T1~2期、1~2个SLN转移且接受全乳放射治疗的保乳乳腺癌患者，可安全豁免ALND[2]。基于这一试验结论，美国国家综合癌症网络(National Comprehensive Cancer Network，NCCN)指南建议对于T1~2期、1~2个阳性SLN、保乳术后、接受全乳放射治疗且无术前治疗患者可免除ALND(2A类推荐)[3]。但ACOSOG Z0011试验中两组患者的中位年龄分别为56岁和54岁，其中<50岁患者仅279例(34%)，占比较低[4]，且国内外关于年轻乳腺癌能否参照ACOSOG Z0011试验结论豁免ALND的研究较少。因此，对于年轻乳腺癌患者，能否参照ACOSOG Z0011试验结论仅行前哨淋巴结活检(sentinel lymph node biopsy，SLNB)而免除ALND值得进一步探讨。本研究探讨ACOSOG Z0011试验结论是否适用于年轻乳腺癌患者，以为制定适合年轻乳腺癌患者的治疗决策提供参考。
1 资料与方法
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1.1 研究资料
回顾性分析2013年2月28日－2018年2月28日在南昌大学第二附属医院及九江学院第二附属医院接受住院治疗的符合ACOSOG Z0011试验入组标准的134例乳腺癌患者的临床资料。根据手术方式不同分为病例组(n=63，仅行SLNB)与对照组(n=71，行SLNB+ALND)，如图1所示。纳入标准：(1)病理证实的女性乳腺癌；(2)年龄≤40岁；(3)行保乳手术；(4)临床T1~2期、1~2个SLN转移；(5)接受术后规范的放化疗。排除标准：(1)双侧乳腺癌；(2)行术前新辅助化疗或放射治疗；(3)伴有其他原发肿瘤；(4)临床数据不完整；(5)手术期间因出现并发症死亡、随访时间不超过3个月。本研究符合《赫尔辛基宣言》，获南昌大学第二附属医院伦理委员会批准(2023-067)，所有患者均签署手术及放化疗知情同意书。
1.2 SLNB与ALND方法
SLNB采用亚甲蓝联合纳米炭示踪法，根据术中冷冻病理切片判断SLN是否存在转移。ALND范围包括Ⅰ、Ⅱ水平腋窝淋巴结(axillary lymph node，ALN)，Ⅲ水平ALN不作清扫。所有患者均接受术后辅助放射治疗，方案为全乳放射治疗(45~50 Gy/4~5周)+瘤床局部追加剂量放疗(10~15 Gy/1~1.5周)。
1.3 临床病理资料收集
收集患者临床病理资料，包括年龄、肿瘤TNM分期、是否妊娠或哺乳期、雌激素受体(estrogen receptor，ER)、孕激素受体(progesterone receptor，PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2，HER2)、Ki-67、脉管内癌栓、肿瘤Nottingham分级等。
1.4 随访
术后第1~2年每3个月随访1次，第3年开始每6个月随访1次。随访方式为医师与患者在门诊复查时面对面访问，如患者未返院复查，则通过电话或微信联系患者或患者家属获取相关随访信息。随访内容包括病史、肿瘤四项(癌胚抗原、癌抗原15-3、糖类抗原19-9、糖类抗原125)、乳腺超声检查、腹部超声检查、胸部CT、放射性核素全身骨扫描、乳腺或ALN穿刺活检(如有必要)等。随访截至2023年2月28日。根据随访结果，计算患者的无病生存期(disease-free survival，DFS)及总生存期(overall survival，OS)。DFS定义为确诊至出现局部或区域复发、远处转移、对侧乳腺癌或随访结束的时间；OS定义为确诊至出现死亡(因任何原因)或随访结束的时间。
1.5 生存率分析
采用Kaplan-Meier法对两组患者的DFS和OS进行分析，绘制生存曲线并进行log-rank检验。
1.6 年轻乳腺癌患者预后的影响因素分析
采用多因素Cox比例风险回归模型分析仅行SLNB对年轻乳腺癌患者预后的影响，多因素Cox回归变量筛选采用Enter法(全部变量进入)。检验水准α为0.05。
1.7 统计学处理
采用SPSS 20.0软件进行统计分析。采用Shapiro-Wilk法检验计量资料是否符合正态分布，符合正态分布的计量资料以$\bar{x}±s$表示，组间比较采用独立样本ｔ检验；不符合正态分布的计量资料以M(Q1，Q3)表示，组间比较采用Mann-Whitney U非参数检验。计数资料以例(%)表示，组间比较采用Pearson χ2或Fisher确切概率法。P<0.05为差异有统计学意义。
2 结果
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2.1 两组临床病理资料比较
两组年龄、妊娠或哺乳状态、肿瘤T分期、肿瘤分子分型、肿瘤Nottingham分级及脉管内癌栓等差异均无统计学意义(P>0.05，表1)。
2.2 两组生存率比较
134例乳腺癌患者均获得5年定期随访，年龄为(34.3±4.2)岁，5年DFS率为74.6%，5年OS率为83.6%。
病例组患者5年DFS率为66.7%，DFS为(53.0±1.4)个月；对照组患者5年DFS率为81.7%，DFS为(57.2±0.8)个月；两组间5年DFS率比较差异有统计学意义(P=0.033，图2)。病例组患者5年OS率为77.8%，OS为(56.7±1.0)个月；对照组患者5年OS率为88.7%，OS为(58.5±0.6)个月；两组间5年OS率比较差异无统计学意义(P=0.085，图2)。
2.3 年轻乳腺癌患者预后的影响因素分析
多因素Cox比例风险回归模型分析结果显示，三阴型乳腺癌、肿瘤Nottingham Ⅲ级、仅行SLNB为年轻乳腺癌患者DFS的独立危险因素(P<0.05)；三阴型乳腺癌为年轻乳腺癌患者OS的独立危险因素(P<0.05)，各变量均满足等比例风险假定(表2)。
3 讨论
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ACOSOG Z0011试验结果动摇了ALND曾长期作为SLN阳性乳腺癌患者的标准治疗手段，对临床实践产生了深远影响。欧美的一些研究结果显示，大多数外科医师倾向于根据ACOSOG Z0011试验结果更改自己的临床实践方式，并且根据ACOSOG Z0011试验结论行保乳手术降低了患者的住院费用[5-6]，这使得临床T1~2期、1~2个SLN转移且接受全乳放射治疗的保乳乳腺癌患者可免除ALND。虽然ACOSOG Z0011试验意义重大且对临床实践产生了划时代的影响，但亦存在一些缺陷。例如，年轻乳腺癌患者比例较低(34%)。而年龄与患者的肿瘤生物学特性密切相关，Nguyen等[7]发现，<40岁的乳腺癌患者接受保乳手术后局部复发率有高于接受全乳切除术患者的趋势(11.1% vs 4.1%，P=0.078)。有研究将符合ACOSOG Z0011试验入组标准的中国乳腺癌患者的临床病理特征与ACOSOG Z0011试验入组患者的临床病理特征进行了对比分析，发现国内患者的年龄较国外年轻，其余临床病理特征基本一致[8]。提示参照ACOSOG Z0011试验入组标准及诊疗流程，中国将有更多年轻乳腺癌患者免除ALND。因此，年轻乳腺癌能否参照ACOSOG Z0011试验结论安全豁免ALND值得探讨。
对于年轻与中老年乳腺癌患者的年龄界定尚无明确定论，通常将40岁作为年轻乳腺癌的界值[9]。因此，本研究纳入人群为≤40岁。Ⅰ、Ⅱ水平ALND是临床上ALN转移患者的标准治疗[10]，而Ⅲ水平ALND则存在一定争议，其并不是一种常规的治疗。仅在Ⅱ水平ALN存在显著病灶时，才需扩大施行Ⅲ水平ALND[11]。研究表明，Ⅲ水平ALND并不能提高患者的生存率[12]。本研究纳入的研究对象均未行Ⅲ水平ALND。由于病例组患者皆未行ALND，故无法判断其ALN状态，因此两组患者的肿瘤N分期无法比较。年轻乳腺癌具有肿瘤侵袭性强、恶性程度高[13]、预后差[14]等特点。本组患者的5年总OS率为83.6%，André等[15]的研究表明，保乳手术的5年OS率为97.9%，与本研究相差较大，其原因在于本研究对象为年轻乳腺癌患者，其本身预后较差。本研究病例组与对照组患者5年DFS率差异有统计学意义(66.7% vs. 81.7%，P=0.033)，表明年轻乳腺癌豁免ALND具有较高的局部复发率。经多因素分析排除混杂因素，发现仅行SLNB是DFS的独立危险因素(HR=2.403，P=0.017)。因此，临床实践中，对于符合ACOSOG Z0011试验入组标准的年轻乳腺癌，应积极考虑行ALND。与此同时，Ong等[16]对美国国家癌症数据库(National Cancer Database，NCDB)中2009－2014年符合ACOSOG Z0011入组标准的乳腺癌患者进行回顾性分析，发现年轻患者(<40岁)更倾向于接受ALND治疗。由此可见，年龄对乳腺癌患者的临床决策具有一定的影响。但本研究病例组与对照组患者的5年OS率差异无统计学意义(77.8% vs. 88.7%，P=0.085)，经多因素分析排除混杂因素，发现仅行SLNB并不是OS的独立危险因素(HR=2.134，P=0.105)，表明豁免ALND对年轻乳腺癌的OS影响不明显，提示ACOSOG Z0011试验的结论对年轻乳腺癌是适用的。一些研究中心根据ACOSOG Z0011试验结果进行了相似的研究，其结论也提示了ACOSOG Z0011试验结果的适用性[17-19]，但均未对年龄<40岁的患者进行分析。中国一项研究纳入了符合ACOSOG Z0011试验标准的142例乳腺癌患者，其中115例仅接受了SLNB，中位随访29个月后，仅1例(0.9%)患侧乳腺肿瘤复发[20]。提示ACOSOG Z0011标准同样适用于东方乳腺癌人群。因此，对于≥40岁的临床T1~2期、1~2个SLN转移且接受全乳放疗的保乳乳腺癌患者，免除ALND是可接受的；对于<40岁的乳腺癌患者，是否可免除ALND则应持谨慎态度。研究表明，年轻乳腺癌具有临床分期高、淋巴结转移率高及组织学级别高的临床特点[21]，表明年轻乳腺癌侵袭能力强，预后差；另有研究表明，年轻乳腺癌(<35岁)分子分型往往较差，HER2型及三阴型比例高[22]；这可能是ACOSOG Z0011试验结论并不十分适用于年轻乳腺癌的原因。
本研究仍存在不足之处：第一，研究人群筛选过程中，临床数据不完整者比例较高(58.3%)，可能会产生一定的选择偏倚；第二，为单中心、回顾性、小样本研究，且随访时间仅为5年，无法分析符合ACOSOG Z0011试验入组标准的年轻乳腺癌患者豁免ALND是否会对其远期生存率产生影响。有研究表明，美国的保乳手术比例为60％~70％[23]，而国内的保乳手术比例仅为10％~24.3％[24]，其原因在于国内乳腺癌患者的受教育程度、经济状况以及思想观念较欧美等地区具有一定的差异。而中国保乳率与欧美等地区的差异亦限制了ACOSOG Z0011试验结论在中国的应用。虽然ACOSOG Z0011试验结论具有重要的临床实践价值，并已应用于临床，但其本身存在一些不足，如入组患者失访率高达19.3%，术后放射治疗缺乏严格质控，入组年轻患者比例低等[25-27]。
综上所述，本研究结果表明，符合ACOSOG Z0011试验入组标准的年轻乳腺癌豁免ALND具有较高的局部复发率，但OS影响不明显。因此，若能在术后保持随访，且接受规范的术后辅助治疗，年轻乳腺癌可参照Z0011试验结论豁免ALND。
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排序方式：
[1]
Oda G, Nakagawa T, Mori H, et al. Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients[J]. World J Clin Oncol, 2022, 13(9): 748-757.
[2]
Giannakou A, Gooch J, Gergelis KR, et al. De-escalation of axillary surgery in patients outside Z0011 criteria[J]. Surgery, 2023, 174(2): 416-418.
[3]
Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(6): 691-722.
[4]
Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial[J]. Ann Surg, 2016, 264(3): 413-420.
[5]
Caudle AS, Hunt KK, Kuerer HM, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial[J]. Ann Surg Oncol, 2011, 18(9): 2407-2412.
[6]
Mattar D, di Filippo A, Invento A, et al. Economic implications of ACOSOG Z0011 trial application into clinical practice at the European Institute of Oncology[J]. Eur J Surg Oncol, 2021, 47(10): 2499-2505.
[7]
Nguyen DV, Kim SW, Oh YT, et al. Local recurrence in young women with breast cancer: breast conserving therapy vs. mastectomy alone[J]. Cancers (Basel), 2021, 13(9): 2150.
[8]
Liu M, Wang S, Cui S, et al. The feasibility of the ACOSOG Z0011 criteria to Chinese breast cancer patients: a multicenter study[J]. Sci Rep, 2015, 5: 15241.
[9]
Paluch-Shimon S, Cardoso F, Partridge AH, et al. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5)[J]. Ann Oncol, 2022, 33(11): 1097-1118.
[10]
Jinno H, Inokuchi M, Ito T, et al. The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition[J]. Breast Cancer, 2016, 23(3): 367-377.
[11]
Gradishar WJ, Anderson BO, Balassanian R, et al. NCCN guidelines insights: breast cancer, version 1.2017[J]. J Natl Compr Canc Netw, 2017, 15(4): 433-451.
[12]
Tominaga T, Takashima S, Danno M. Randomized clinical trial comparing level Ⅱ and level Ⅲ axillary node dissection in addition to mastectomy for breast cancer[J]. Br J Surg, 2004, 91(1): 38-43.
[13]
Co M, Kwong A. Young onset breast cancer in Southern China - a 5-year clinico-pathological study from a multi-centre database[J]. Cancer Treat Res Commun, 2020, 24: 100182.
[14]
Wang W, Tian B, Xu X, et al. Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study[J]. Arch Gynecol Obstet, 2023, 307(3): 957-968.
[15]
André C, Holsti C, Svenner A, et al. Recurrence and survival after standard versus oncoplastic breast-conserving surgery for breast cancer[J]. BJS Open, 2021, 5(1): zraa013.
[16]
Ong CT, Thomas SM, Blitzblau RC, et al. Patient age and tumor subtype predict the extent of axillary surgery among breast cancer patients eligible for the American College of Surgeons Oncology Group trial Z0011[J]. Ann Surg Oncol, 2017, 24(12): 3559-3566.
[17]
Hennigs A, Köpke M, Feißt M, et al. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice?[J]. Breast Cancer Res Treat, 2019, 173(2): 429-438.
[18]
Shinzato JY, Serra KP, Eugeni C, et al. Potential impact of the Z0011 trial on the omission of axillary dissection: a retrospective cohort study[J]. Rev Bras Ginecol Obstet, 2021, 43(4): 297-303.
[19]
Dengel LT, van Zee KJ, King TA, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy[J]. Ann Surg Oncol, 2014, 21(1): 22-27.
[20]
Peng Y, Liu M, Li X, et al. Application of the ACOSOG Z0011 criteria to Chinese patients with breast cancer: a prospective study[J]. World J Surg Oncol, 2021, 19(1): 128.
[21]
Li S, Wang X, Yang J, et al. Clinicopathological features and survival of early stage breast cancer in Northwest China: a population-based retrospective study of 1287 patients[J]. Thorac Cancer, 2018, 9(1): 10-18.
[22]
Kataoka A, Tokunaga E, Masuda N, et al. Clinicopathological features of young patients (<35 years of age) with breast cancer in a Japanese Breast Cancer Society supported study[J]. Breast Cancer, 2014, 21(6): 643-650.
[23]
Macfie R, Aks C, Panwala K, et al. Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage Ⅱ triple negative breast cancer[J]. Am J Surg, 2021, 221(4): 809-812.
[24]
Yang Q, Zhong X, Zhang W, et al. Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China[J]. BMC Cancer, 2021, 21(1): 107.
[25]
Jagsi R, Chadha M, Moni J, et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial[J]. J Clin Oncol, 2014, 32(32): 3600-3606.
[26]
Livingston EH, Li HC. Breast cancer surgery: less is more[J]. JAMA, 2017, 318(10): 909-911.
[27]
Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial[J]. JAMA, 2017, 318(10): 918-926.
2024年第49卷第12期
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doi: 10.11855/j.issn.0577-7402.1155.2024.0418
  • 接收时间：2023-08-31
  • 首发时间：2025-11-20
  • 出版时间：2024-12-28
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  • 收稿日期：2023-08-31
  • 录用日期：2023-11-01
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    1九江学院第二附属医院普通外科，江西九江 332005
    2南昌大学第二附属医院乳腺外科，江西南昌 330006
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