根據(jù)目前的TNM分期系統(tǒng),，乳腺癌對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移屬于M1和IV期病變。由于對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移的意義及其治療方法（究竟根治切除治療還是單純姑息治療）研究數(shù)據(jù)缺乏,，故其處理原則仍不確定,，無(wú)疑給臨床帶來(lái)巨大挑戰(zhàn)。

　　2020年5月21日,，美國(guó)腫瘤外科學(xué)會(huì)和美國(guó)乳腺外科醫(yī)師學(xué)會(huì)官方期刊《腫瘤外科學(xué)報(bào)》在線發(fā)表歐洲腫瘤研究院,、意大利米蘭大學(xué)、米蘭比科卡大學(xué)的研究報(bào)告,，調(diào)查了乳腺癌對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移患者的治療方法和生存結(jié)局,。

　　該單中心回顧研究對(duì)1997年以來(lái)意大利米蘭歐洲腫瘤研究院病理證實(shí)對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移的47例尚未發(fā)生遠(yuǎn)處轉(zhuǎn)移患者進(jìn)行回顧分析?？尚兄委煼椒òㄊ中g(shù)、放療和全身治療,。主要結(jié)局為無(wú)病生存和總體生存,。

　　結(jié)果發(fā)現(xiàn)，原發(fā)腫瘤確診后發(fā)生對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移的中位時(shí)間為73個(gè)月（范圍5～500個(gè)月）,。其中,，保乳手術(shù)25例、乳房切除22例,，放療33例,，腋窩清掃46例、前哨淋巴結(jié)活檢1例,，化療23例,、化療＋內(nèi)分泌治療9例、內(nèi)分泌治療14例,。

　　經(jīng)過(guò)中位隨訪5.4年（四分位距：2.9～7.0年）

• 5年總體生存比例：72%（95%置信區(qū)間：54～83）

• 8年總體生存比例：61%（95%置信區(qū)間：43～75）

• 5年無(wú)病生存比例：61%（95%置信區(qū)間：44～74）

• 8年無(wú)病生存比例：42%（95%置信區(qū)間：25～59）

　　因此,，該研究結(jié)果表明，如果對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移接受以根治為目的的手術(shù)和全身治療,，與其他部位遠(yuǎn)處轉(zhuǎn)移相比,，患者生存結(jié)局相對(duì)較好，尤其總體生存,。

　　對(duì)此,，作者提出一種新的臨床方案：TNM分期系統(tǒng)不應(yīng)將對(duì)側(cè)腋窩淋巴結(jié)轉(zhuǎn)移歸入M1和IV期，而是應(yīng)該歸入N3期病變。

Ann Surg Oncol. 2020 May 21. [Epub ahead of print]

Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging?

Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M.

European Institute of Oncology, IRCCS, Milan, Italy; University of Milan, Milan, Italy; University of Milan-Bicocca, Milan, Italy.

BACKGROUND: Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge.

PATIENTS AND METHODS: Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS).

RESULTS: Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59).

CONCLUSION: These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.

PMID: 32436193

DOI: 10.1245/s10434-020-08605-4