C Bonneau1, D Hequet2, J P Estevez3, N Pouget1, R Rouzier4. 1. Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France. 2. Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France; EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles-St-Quentin-en-Yvelines University, France. 3. Department of Surgical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France. 4. Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France; EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles-St-Quentin-en-Yvelines University, France. Electronic address: roman.rouzier@curie.fr.
Abstract
AIM: The objective of this study was to determine the effects of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy alone (SLNB) on the survival of patients with 3 or more metastatic lymph nodes (MLN) in invasive breast cancer. METHODS: Data of 9521 patients with invasive T1-2M0 breast carcinoma and initial treatment with SLNB completed or not by ALND and 3 or more MLN were extracted from the SEER database. Univariate and multivariate analyses were performed. RESULTS: Overall, 9521 patients were included in the study. SLNB-alone compared with ALND did not result in different overall survival (OS) or specific survival (SS) for patients with 3 or more MLN (p = 0.46 and 0.58, respectively). In subgroup analyses, OS was comparable between SLNB-alone and ALND when patients had only 3 or more than 3 MLN. When patients had 3 MLN, the 5-year SS was significantly better for patients with ALND compared with SLNB-alone: 91.5% and 85.1%, respectively (p = 0.02). The Hazard Ratio (HR) for OS comparing SLNB-alone with ALND adjusting for age, adjuvant radiotherapy, tumor size, estrogen receptor status, grade and tumor type resulted in an HR of 1.05 (95% CI, 0.72-1.54, p = 0.77). CONCLUSION: In conclusion, patients with a T1-T2 invasive breast cancer and at least 3 MLN do not benefit from ALND after SLNB for specific and overall survival, thus limiting ALND to a staging procedure. A subgroup of patients with 3 MLN had a better SS with ALND, possibly due to an under-staging of the SLNB-alone group.
RCT Entities:
AIM: The objective of this study was to determine the effects of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy alone (SLNB) on the survival of patients with 3 or more metastatic lymph nodes (MLN) in invasive breast cancer. METHODS: Data of 9521 patients with invasive T1-2M0 breast carcinoma and initial treatment with SLNB completed or not by ALND and 3 or more MLN were extracted from the SEER database. Univariate and multivariate analyses were performed. RESULTS: Overall, 9521 patients were included in the study. SLNB-alone compared with ALND did not result in different overall survival (OS) or specific survival (SS) for patients with 3 or more MLN (p = 0.46 and 0.58, respectively). In subgroup analyses, OS was comparable between SLNB-alone and ALND when patients had only 3 or more than 3 MLN. When patients had 3 MLN, the 5-year SS was significantly better for patients with ALND compared with SLNB-alone: 91.5% and 85.1%, respectively (p = 0.02). The Hazard Ratio (HR) for OS comparing SLNB-alone with ALND adjusting for age, adjuvant radiotherapy, tumor size, estrogen receptor status, grade and tumor type resulted in an HR of 1.05 (95% CI, 0.72-1.54, p = 0.77). CONCLUSION: In conclusion, patients with a T1-T2 invasive breast cancer and at least 3 MLN do not benefit from ALND after SLNB for specific and overall survival, thus limiting ALND to a staging procedure. A subgroup of patients with 3 MLN had a better SS with ALND, possibly due to an under-staging of the SLNB-alone group.
Authors: Caitlin E Marks; Yi Ren; Laura H Rosenberger; Samantha M Thomas; Rachel A Greenup; Oluwadamilola M Fayanju; Susan McDuff; Gretchen Kimmick; E Shelley Hwang; Jennifer K Plichta Journal: J Surg Res Date: 2020-05-29 Impact factor: 2.192
Authors: Roland G Stein; Roland Fricker; Thomas Rink; Hartmut Fitz; Sebastian Blasius; Joachim Diessner; Sebastian F M Häusler; Tanja N Stüber; Victoria Andreas; Achim Wöckel; Thomas Müller Journal: Breast Care (Basel) Date: 2017-10-20 Impact factor: 2.860
Authors: Almir Jose Sarri; Eduardo Tinois da Silva; Rene Aloisio da Costa Vieira; Katia Hiromoto Koga; Pedro Henrique Moriguchi Cação; Vitor Coca Sarri; Sonia Marta Moriguchi Journal: Breast Cancer (Dove Med Press) Date: 2017-04-19