PURPOSE The optimal management of breast cancer patients with a positive sentinel lymph node (SLN) who undergo mastectomy remains controversial. This study aimed to describe treatment patterns of patients with positive SLNs who undergo mastectomy using a large population-based database. METHODS The NCDB was queried for cT1-2N0 breast cancer patients treated with mastectomy between 2006 and 2014 who had 1-2 positive SLNs. Patients receiving neoadjuvant chemotherapy were excluded. Axillary management included SLN dissection (SLND) alone, axillary lymph node dissection (ALND), post-mastectomy radiation (PMRT) alone, and ALND + PMRT. Trends of axillary management and patient characteristics were examined. RESULTS Among 12,190 patients who met study criteria, the use of ALND dropped with a corresponding increase in other approaches. In 2006, 34% of patients had SLND alone, 47% ALND, 8% PMRT and 11% ALND + PMRT. By 2014, 37% had SLND, 23% ALND, 27% PMRT and 13% ALND + PMRT. Patients who underwent SLND alone were older (mean 60.6 years) with more comorbidities (Charlson-Deyo score > 2), smaller primary tumors (mean 2.1 cm), well-differentiated histology, hormone receptor-positive, HER2-negative tumors, without lymphovascular invasion (all P values < 0.01). Treatment with SLND alone was more likely if patients had only one positive SLN (P < 0.001) or micrometastatic disease (P < 0.001), and were treated at community centers compared with academic centers (P < 0.001). CONCLUSIONS The management of breast cancer patients undergoing mastectomy with positive SLNs has evolved over time with decreased use of ALND and increased use of radiation. Some patient subsets are underrepresented in recent clinical trials, and therefore, future trials should focus on these patients.

中文翻译：

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1-2个前哨淋巴结阳性的患者行乳房切除术后腋窝管理实践模式的演变。

目的对乳房切除术阳性前哨淋巴结（SLN）的乳腺癌患者进行最佳治疗仍存在争议。这项研究的目的是使用基于人群的大型数据库来描述接受乳腺切除术的阳性SLN患者的治疗方式。方法对NCDB进行查询，查询2006年至2014年间经乳房切除术治疗的1-2例SLN阳性的cT1-2N0乳腺癌患者。排除接受新辅助化疗的患者。腋窝管理包括单独的SLN解剖（SLND），腋窝淋巴结清扫（ALND），单独的乳房切除术后放疗（PMRT）和ALND + PMRT。检查了腋窝管理趋势和患者特征。结果在满足研究标准的12190名患者中，ALND的使用有所下降，而其他方法的使用也相应增加。在2006年，34％的患者仅接受SLND，47％的ALND，8％的PMRT和11％的ALND + PMRT。到2014年，有37％的人拥有SLND，23％的ALND，27％的PMRT和13％的ALND + PMRT。单独接受SLND的患者年龄较大（平均60.6岁），合并症更多（Charlson-Deyo得分> 2），较小的原发肿瘤（平均2.1 cm），组织学高度分化，激素受体阳性，HER2阴性肿瘤，无淋巴管炎入侵（所有P值<0.01）。如果患者只有一种SLN阳性（P <0.001）或微转移性疾病（P <0.001），并且在社区中心接受治疗，而与学术中心相比（P <0.001），则仅用SLND进行治疗的可能性更高。结论随着时间的流逝，随着ALND使用量的减少和放射线的使用量的增加，乳腺切除术阳性SLNs的乳腺癌患者的治疗已逐步发展。