目的 保乳术中不进行腋窝淋巴结清扫(ALND)对前哨淋巴结活检(SLNB)阴性早期乳腺癌患者近期疗效与远期预后的影响.方法 纳入山西省肿瘤医院2019年1月至2022年1月收治的SLNB阴性早期乳腺癌患者124例,根据保乳术中是否进行ALND分成A组(66例)与B组(58例),A组未行ALND术,B组行ALND术.比较两组手术时间、术中出血量、术后引流量、住院时间及手术前后的血清糖类抗原153(CA153)、癌胚抗原(CEA)水平,记录并发症情况.利用SF-36生活质量量表评估术前、术后1个月的生活质量.术后通过电话或复查形式随访,截止时间为2024年1月.记录术后2年的乳腺癌复发率、转移率.计数资料组间比较用x2检验,满足正态分布与方差齐性的计量资料组间比较用t检验.结果 A组手术时间、住院时间短于B组[(79.25± 5.87)min 比(91.31±8.95)min,t=8.972,P＜0.05;(10.31±2.40)d 比(13.49±3.07)d,t=6.464,P＜0.05],术中出血量、术后引流量低于 B 组[(80.06±7.49)ml 比(102.44±11.62)ml,t=12.896,P＜0.05;(108.75±16.98)ml 比(42.48±13.64)ml,t=12.084,P＜0.05].两组术后血清 CA153、CEA 水平低于术前[(9.41±1.45)U/ml 比(16.93±2.91)U/ml,t=1.898,P＜0.05;(9.34±2.07)U/ml 比(17.95±3.88)U/ml,t=0.832,P＜0.05;(22.12±3.67)ng/ml 比(60.48± 7.46)ng/ml,t=1.253,P＜0.05;(21.46±5.19)ng/ml 比(61.69±8.92)ng/ml,t=1.265,P＜0.05],但术前、术后7 d组间各指标比较差异无统计学意义(t=1.668、0.220、0.822、0.825,P＞0.05).两组术后1个月精神健康、生理机能、躯体疼痛、生理职能、一般健康状况、社会功能、情感职能、精力评分高于术前,且 A 组高于 B 组(t=5.235、4.365、4.213、6.345、3.564、3.254、5.843、2.185,P＜0.05).A组术后2年复发率、转移率分别为7.58％、3.03％,与B组(5.17％、1.72％)比较差异无统计学意义(x2=0.031、0.013,P＞0.05).结论 保乳术中SLNB阴性早期乳腺癌患者术中不行ALND术能促进围术期恢复、减少并发症发生、提高近期生活质量、远期预后理想且未增加远期复发率、转移率.
Effect of axillary lymph node dissection not performed during breast conserving surgery on short-term efficacy and long-term prognosis of sentinel lymph node biopsy-negative early breast cancer patients
Objective To investigate the effect of axillary lymph node dissection(ALND)not per-formed during breast conserving surgery on the short-term outcome and long-term prognosis of patients with sentinel lymph node biopsy(SLNB)negative early breast cancer.Methods A total of 124 patients with SLNB-negative early breast cancer admitted to our hospital from January 2019 to January 2022 were divided into group A(n=66)and group B(n=58)according to whether ALND was performed during breast-con-serving surgery.Group A did not undergo ALND,and group B underwent ALND.The operation time,intr-aoperative blood loss,postoperative drainage volume,hospital stay and the levels of serum carbohydrate an-tigen 153(CA153)and carcinoembryonic antigen(CEA)before and after operation were compared between the two groups,and the complications were recorded.SF-36 Quality of life scale was used to evaluate the quality of life before and one month after surgery.Follow-up was conducted by telephone or review until January 2024.The recurrence rate and metastasis rate of breast cancer were recorded 2 years after opera-tion.The x2test was used for comparison of counting data between groups,and the t test was used for com-parison of measurement data between groups that met the normal distribution and homogeneity of variance.Results The operation time and hospital stay in group A were shorter than those in group B[(79.25± 5.87)min vs.(91.31±8.95)min,t=8.972,P＜0.05;(10.31±2.40)d vs.(13.49±3.07)d,t=6.464,P＜0.05],and the amount of blood loss and postoperative drainage volume were lower in group A than those in group B[(80.06±7.49)ml vs.(102.44±11.62)ml,t=12.896,P＜0.05;(108.75± 16.98)ml vs.(42.48±13.64)ml,t=12.084,P＜0.05].The levels of serum CA153 and CEA in groups A and B after surgery were lower than before surgery[(9.41±1.45)vs.(16.93±2.91)U/ml,t=1.898,P＜0.05;(9.34±2.07)vs.(17.95±3.88)U/ml,t=0.832,P＜0.05;(22.12±3.67)vs.(60.48±7.46)ng/ml,t=1.253,P＜0.05;(21.46±5.19)vs.(61.69±8.92)ng/ml,t=1.265,P＜0.05],but there was no significant difference between the two groups before surgery and 7 days after surgery(t=1.668,0.220,0.822,0.825,P＞0.05).The scores of mental health,physiological function,physical pain,physiological function,general health status,social function,emotional function and energy in group A were significantly higher than those in group B one month after operation(t=5.235,4.365,4.213,6.345,3.564,3.254,5.843,2.185,P＜0.05).The recurrence rate and metastasis rate in group A were 7.58％and 3.03％,and those were 5.17％and 1.72％in group B(x2=0.031,0.013,P＞0.05),respectively.Conclusion In the patients with SLNB-negative early breast cancer,ALND can promote perioperative recovery,reduce the occurrence of complications,improve the short-term quality of life,and has a good long-term prognosis without increasing the rate of recurrence and metastasis.
Sentinel lymph node biopsyEarly breast cancerBreast-conserving surgeryAxillary lymph node dissectionPrognosis
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