ACOSOG Z0011 研究表明，对于有 1-2 个转移性前哨淋巴结 (SLN) 并同时进行保乳和术后放疗的患者，可以考虑进行腋窝淋巴结清扫术 (ALND)。然而，这种方法对于接受乳房切除术的患者的适用性仍存在争议。我们研究的目的是确定患有 1-2 个转移性 SLN 并接受乳房切除术的乳腺癌患者选择 ALND 的预后差异和风险因素。该研究对诊断为 cT1- 的患者进行了回顾性分析。 2016年1月至2021年12月期间在河北医科大学第四医院接受治疗的2N0乳腺癌患者，根据前哨淋巴结活检（SLNB）后是否进行ALND分为两个队列：SLNB队列和SLNB ALND队列。结果包括局部复发率（LRR）、无病生存率（DFS）和总生存率（OS）。进行倾向评分匹配（PSM）以确保两个队列之间变量的平衡。采用Cox比例风险模型来确定与生存相关的单变量和多变量相对风险。共纳入812例病例。 PSM之后，匹配了234个接收ALND和234个未接收ALND。观察到的中位随访期为 56.72 ± 20.29 个月。在此期间，SLNB ALND 队列和 SLNB 队列的 DFS 和 OS 没有显着差异（P = 0.208 和 P = 0.102），除了 40 岁以下的患者外，SLNB ALND 组与 SLNB 组相比 LRR 有所降低。 SLNB 组（11.1% vs. 2.12%，P = 0.044）。多变量 Cox 分析显示，年轻（≤ 40 岁）、孕激素受体（PR）阴性和单独 SLNB 是 LRR 的独立危险因素；神经周围侵犯是一个危险因素，而内分泌治疗是激素受体阳性患者 DFS 和 OS 的有益预后指标。ALND 不会影响已完成乳房切除术的 1-2 个转移性 SLN 患者的 DFS 和 OS。年龄较小（≤ 40 岁）、PR 阴性以及单独接受 SLNB 是 LRR 的独立危险因素。鉴于这一发现，我们建议对没有危险因素的患者避免进行腋窝治疗，例如 ALND 或放射治疗。版权所有 © 2024 赵、杨、曹和宋。

The ACOSOG Z0011 study has shown that axillary lymph node dissection (ALND) is an option to be considered in patients who had 1-2 metastatic sentinel lymph nodes (SLNs) who proceed with breast-conserving along with postoperative radiotherapy. However, there remains controversy regarding the applicability of this approach in patients who had a mastectomy. The aim of our study is to determine the prognostic differences and risk factors associated with the decision to opt for ALND in breast cancer patients who had 1-2 metastatic SLNs who receive a mastectomy.The study conducted a retrospective analysis of patients diagnosed with cT1-2N0 breast cancer and treated at The Fourth Hospital of Hebei Medical University between January 2016 and December 2021, and patients were divided into two cohorts according to whether ALND was performed after sentinel lymph node biopsy (SLNB): SLNB cohort and SLNB + ALND cohort. Outcomes included the locoregional recurrence rate (LRR), disease-free survival (DFS), and overall survival (OS). Propensity score matching (PSM) was conducted to ensure the balance of variables between the two cohorts. Cox proportional hazard models were employed to ascertain the univariate and multivariate relative risks associated with survival.There were 812 cases enrolled. After the PSM, 234 receiving ALND and 234 not receiving ALND were matched. A median follow-up period of 56.72 ± 20.29 months was observed. During that time, no significant difference was identified in the DFS and OS in the SLNB + ALND cohort and the SLNB cohort (P = 0.208 and P = 0.102), except for those under 40 years old, SLNB + ALND group showed a reduction in LRR compared to SLNB group (11.1% vs. 2.12%, P = 0.044). Multivariate Cox analysis showed that younger (≤ 40 years), progesterone receptor (PR)-negative, and SLNB alone were independent risk factors for LRR; perineural invasion was a risk factor, while endocrinotherapy was a beneficial prognostic indicator for DFS and OS among patients with positive hormone receptor.ALND does not impact DFS and OS in patients with 1-2 metastatic SLNs who have completed a mastectomy. Being younger (≤ 40 years), having a negative PR, and undergoing SLNB alone were independent risk factors for LRR. Given this finding, we recommend avoiding axillary treatment such as ALND or radiotherapy in patients without risk factors.Copyright © 2024 Zhao, Yang, Cao and Song.