Neoadjuvant Chemotherapy And Axillary Lymph Nodes: Factors Affecting Lymph Node Yield In Patients Undergoing Axillary Node Dissection

Abstract

İntroduction: This study aims to investigate the impact of neoadjuvant chemotherapy (NAC) on the number of lymph nodes dissected during axillary lymph node dissection (ALND) in breast cancer patients, a topic of significant debate among surgeons and pathologists. Material and Methods: We conducted a retrospective analysis of 440 breast cancer patients who underwent surgery between January 1, 2018, and December 31, 2020. Patients were categorized into two groups based on NAC administration. We collected demographic, clinical, and pathological data, focusing on the total and malignant lymph node counts. Results: Among the 440 patients, 124 received NAC, while 316 did not. The mean number of lymph nodes removed was 18.1 in total, with 17.2 in the NAC group and 18.5 in the non-NAC group (P = 0.17). No significant differences were observed in the number of malignant lymph nodes between the two groups (P = 0.73). However, multivariate analysis indicated that NAC significantly influenced the total number of lymph nodes dissected (P = 0.05). Additionally, lymphovascular invasion (LVI) was found to significantly impact the number of malignant lymph nodes. Conclusion: Our findings suggest that NAC is associated with a reduced number of lymph nodes dissected during ALND in breast cancer patients. These results indicate that the standard guideline of removing at least 10 lymph nodes may require reconsideration for patients undergoing NAC. Further studies are needed to clarify the implications of these findings for staging and treatment protocols.

Keywords

• Neoadjuvant chemotherapy
• Axillary dissection
• Lymph node retrieval

Neoadjuvan Kemoterapi ve Aksiller Diseksiyon İlişkisi: Çıkartılan Lenf Nodu Sayısını Etkileyen Faktörler

Öz

Giriş: Bu çalışma, cerrahlar ve patologlar arasında önemli bir tartışma konusu olan, meme kanseri hastalarında aksiller lenf nodu diseksiyonu (ALND) sırasında diseke edilen lenf nodu sayısına neoadjuvan kemoterapinin (NAC) etkisini araştırmayı amaçlamaktadır. Gereç ve Yöntemler: 1 Ocak 2018 ile 31 Aralık 2020 tarihleri arasında ameliyat geçiren 440 meme kanseri hastası üzerinde retrospektif bir analiz gerçekleştirdik. Hastalar, NAC uygulamasına göre iki gruba ayrıldı. Çıkartılan toplam ve malign lenf nodu sayılarına odaklanarak demografik, klinik ve patolojik verileri topladık. Sonuç: 440 hastanın 124'üne NAC uygulanırken, 316'sına uygulanmadı. Çıkarılan lenf nodlarının ortalama sayısı toplamda 18,1 idi; NAC grubunda 17,2, NAC uygulanmayan grupta ise 18,5 idi (P = 0,17). İki grup arasında malign lenf nodu sayısında anlamlı bir fark gözlenmedi (P = 0,73). Ancak, çok değişkenli analiz, NAC'nin çıkarılan toplam lenf nodu sayısını önemli ölçüde etkilediğini gösterdi (P = 0,05). Ayrıca, lenfovasküler invazyonun (LVI) malign lenf nodu sayısını önemli ölçüde etkilediği bulundu. Tartışma: Bulgularımız, NAC'nin meme kanseri hastalarında ALND sırasında diseke edilen lenf nodu sayısının azalmasıyla ilişkili olduğunu göstermektedir. Bu sonuçlar, en az 10 lenf nodunun çıkarılmasına ilişkin standart kılavuzun, NAC uygulanan hastalar için yeniden gözden geçirilmesi gerektiğini düşündürmektedir. Bu bulguların evreleme ve tedavi protokolleri üzerindeki etkilerini açıklığa kavuşturmak için daha fazla çalışma yapılması gerekmektedir.

Anahtar Kelimeler

• Neoadjuvan kemoterapi
• Aksiller diseksiyon
• Lenf nodu alınması
• Meme kanseri cerrahisi

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