最新乳腺癌前哨淋巴结与放疗ppt课件.ppt

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1、乳腺癌前哨淋巴结与放疗前哨淋巴结活检ahighlevelaccuracyfalsenegativeratearound7%equivalentoncologicaloutcomesintermsofdistantdisease-freeandoverallsurvivalsurprisinglylowregionalrecurrencerateoflessthan1%前哨淋巴结活检negativeSN---completionALNDisnotrequiredACOSOG-Z0011May1999-Dec2004115sitesACOSOG-Z0011

2、Eligibilitycriteriaolderthan18years,T1-2invasivebreastcancer,nopalpableaxillaryadenopathy,and1or2SNmetastasiswithoutextranodalextensionACOSOG-Z0011ExclusioncriteriaClinicallynodepositivediseasemorethan2positivesentinelnodes,mattednodes,grossextranodaldiseasePreoperativesystemict

3、reatmentsisolatedtumourcells(ITC)intheSNACOSOG-Z0011Stratificationage(youngerorolderthan50years)ERstatustumoursize(<1cm,1-2cm,>2cm)ACOSOG-Z0011BCSandSNBSNmetastasisin1or2nodesrandomlyassignedALNDornofurtheraxillaryALNDadissectionofatleast10lymphWBISystemicadjuvanttherapyACOSOG-Z

4、0011ThemainoutcomemeasureoverallsurvivalSecondaryoutcomemeasurediseasefreesurvivalACOSOG-Z0011noninferioritytrialtheSNB-onlygrouphavinga5-yearOSnotlessthan75%ofALNDgroupTargetedenrolmentwas1900womenwithafinalanalysisafter500deaths.ACOSOG-Z0011Thetrialwasclosed891patientsduetolow

5、erthanexpectedaccrualandeventratesACOSOG-Z0011445ALND446SNbiopsyalone35patients(25ontheALNDarmand10ontheSNBarm)excludedbecausewithdrewconsentACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011ACOSOG-Z0011limitedSNmetastaticbreastcancerBreastconservationandsy

6、stemictherapy,SNBalonecomparedwithALNDdidnotresultininferiorsurvivalACOSOG-Z0011PotentialproblemsstatisticaldesignandinterpretationenrolmentofpatientsimbalancesbetweenthetreatmentgroupsandmissingdataACOSOG-Z0011Theplannedtargetaccrual1900patients-apredictionofanoverallsurvivalra

7、teof80%at5yearsforwomenwithoptimallytreatednode-positivebreastcancerThestudyhadaslowaccrual(115sitesover4yearsleadingto<900patientsesomecentresenteredlessthan3patientswhichisnotmanypersite),wasunabletocompleteenrolment,andthereforeclosedearlywithlessthan50%ofthetargetedaccrualan

8、dwithlower-than-expectedeventratesACOSOG-Z0011a