| Objective: Previous studies have shown that positive internal mammary node dissection(PIMND),despite the better local control,has no long-term survival benefits and a certain risk of intraoperative and postoperative complications.There are,however,many controversies concerning clinical significance of PIMND.The purpose of this study was to explore the effect of PIMND on the prognosis of patients with primary breast cancer under the current concept of breast cancer treatment,and to find out the people who might benefit from PIMND,so as to develop better individualized treatment plans for patients.Methods: A retrospective analysis of 133 patients with internal mammary lymph nodes(IMLN)metastasis of breast cancer(BC)that confirmed pathologically by The Forth Hospital of Hebei Medical University from 2009 to 2018.All patients received neoadjuvant chemotherapy and breast and axillary surgery.The patients were divided into PIMND group(n=37)and non-PIMND group(n=96).Overall Survival(OS),disease-free survival(DFS),locoregional disease-free survival(LDFS)and breast cancer specific survival(BCSS)were compared between the two groups.Furthermore,according to the status of supraclavicular and/or infraclavicular lymph nodes,different molecular typing,and the efficacy of neoadjuvant chemotherapy,a stratified analysis was conducted on the two groups to analyze the prognostic effect of PIMND on specific populations.Results:1.According to the survival analysis of patients with positive internal mammary node dissection group and positive internal mammary node non-dissection group,the 5-year overall survival rates of the two groups were 74.3% and 72.6% respectively,and the 5-year breast cancer specific survival rates were 74.3% and 75.1% respectively.The rates of 5-year disease-free survival were 65.1% and 67.6%,respectively,and the rates of 5-year locoregional disease-free survival were 91.5% and 89.2%,respectively.No statistically significant correlation was observed between PIMND group and non-PIMND group(OS:P=0.634,BCSS:P=0.807,DFS: P=0.817,LDFS: P=0.909,log-rank test).2.The effect of PIMND on the prognosis of the general population was(OS: HR=0.820,95%CI= 0.363?1.856;DFS: HR= 0.924,95%CI=0.475? 1.801;LDFS: HR=0.925,95%CI=0.245?3.488).In patients with supraclavicular and/or infraclavicular lymph node metastasis,PIMND reduced the risk of death by 29% and recurrence by 37%(OS:HR=0.714,95%CI= 0.144?3.538;DFS: HR=0.632,95%CI=0.170?2.341).In triple negative patients,PIMND reduced the risk of recurrence by 58%(DFS:HR= 0.423,95%CI=0.051?3.520).In patients with tumor-downstaging after neoadjuvant chemotherapy,PIMND was more likely to bring survival benefits(OS: HR=0.656,95% CI=0.213? 2.022;DFS:HR=0.778,95%CI= 0.284? 2.131;LDFS:HR=0.450,95%CI= 0.054?3.743).PIMND may benefit patients who received radiotherapy of IMLN drainage area and metastatic lymph nodes(OS: HR=0.542,95%CI=0.181?1.626;DFS: HR=0.769,95% CI=0.347?1.707;LDFS: HR= 0.769,95%CI=0.347?1.707).Among those patients who underwent radiotherapy of the IMLN drainage area and were down-staging after neoadjuvant chemotherapy,PIMND tended to benefit from OS,DFS and LDFS.In patients with supraclavicular and/or infraclavicular lymph node metastasis,PIMND may bring benefits of OS and DFS.In triple negative patients,dissection may bring the benefit of DFS.Conclusions:1.Although the 5 years OS and LDFS were higher in the dissection group,the 5 years BCSS and DFS tended to increase with the prolonged follow-up time,but there was no statistical difference between the two groups.IMLN dissection did not bring a better prognosis.2.Further subgroup analysis also found no significant clinical value in specific populations for IMLN dissection. |
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