在节点阳性乳腺癌系统治疗后,用于响应导向的子治疗的种子标记协议
Annemiek K E van Hemert1, Ariane A van Loevezijn1, Marie-Sophie P D Baas1
1Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
JAMA oncology
|August 28, 2025
概括
在初级全身治疗 (PST) 后实现完整反应的结节阳性乳腺癌患者使用MARI协议的响应引导治疗是安全的. 这种方法显著减少了股复发,并避免了符合条件的患者过度治疗.
科学领域:
- 癌症学
- 外科瘤学
- 乳腺癌研究
背景情况:
- 大多数结节阳性乳腺癌患者在初级全身治疗 (PST) 后接受下淋巴结剖析 (ALND) 或放射治疗 (RT).
- 在PST后达到病理完整响应 (pCR) 的患者中,关治疗的必要性是不确定的,这可能导致过度治疗.
研究的目的:
- 评估以反应为指导的关治疗策略的瘤结果.
- 在临床结节阳性 (cN+) 乳腺癌患者中评估MARI (种子标记) 淋巴结协议的疗效.
主要方法:
- 一个单一中心的队列研究包括使用MARI协议治疗的有限的下淋巴结的cN+乳腺癌患者 (2014年7月至2021年12月).
- 患者在PST后接受了MARI标记的淋巴结切除. 患有pCR (ypN0) 的人避免了进一步的关治疗; 患有残留疾病 (ypN+) 的人接受了RT.
- 分析了瘤结局,包括腹复发,5年无侵袭性疾病存活率 (iDFS) 和整体存活率 (OS).
主要成果:
- 在350名患者中,有135名 (39%) 患有ypN0,并且没有接受进一步的关治疗.
- 股复发率较低: ypN0患者为0. 7%, ypN+患者为2. 3%.
- 五年iDFS为ypN0的93%和ypN+的87%;五年OS为ypN0的98%和ypN+的93%.
结论:
- 使用MARI协议进行的响应导向关治疗与特定的cN+乳腺癌患者在PST后出现非常低的关复发风险有关.
- 这一策略有效地识别出可以避免股过度治疗的患者,同时保持出色的瘤结果.
- 根据治疗反应,MARI方案提供了一种可行的缓解关治疗方法.
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