Rachael Snow1, Chantal Reyna2, Caroline Johns1, M Catherine Lee2, Weihong Sun2, William J Fulp3, John V Kiluk4, Christine Laronga5. 1. Morsani College of Medicine, University of South Florida, Tampa, FL, USA. 2. Department of Breast Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. 3. Department of Biostatistics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. 4. Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Department of Breast Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. 5. Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Department of Breast Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. Electronic address: christine.laronga@moffitt.org.
Abstract
BACKGROUND: American College of Surgeons Oncology Group Z0011 trial of select node-positive breast cancer patients demonstrated no survival or recurrence differences between SLN/axillary lymph node dissection (ALND) vs SLN. Our comparable node-positive lumpectomy and mastectomy populations should have similar outcomes. METHODS: An Institutional Review Board approved, retrospective review of pathologic SLN (N1) cases was performed. Treatment, recurrence, and survival were collected. Statistics was analyzed via exact chi-square test with Monte Carlo estimation, Kaplan-Meier curves, and log-rank tests. RESULTS: Of 528 node-positive patients, 318 patients met criteria: 28 (21.7%) lumpectomy, 32 (16.9%) mastectomy had SLN; 101 (78.2%) lumpectomy, 157 (83.0%) mastectomy had SLN + ALND. Median age was 57.5 years for SLN and 53 years for SLN + ALND (P = .003). Mean positive nodes were 1.1 for SLN and 1.47 for SLN + ALND (P = .0018). Chemotherapy use differed (SLN = 73.5%, SLN + ALND = 89.7%, P = .0032). Stage and recurrence were higher for SLN + ALND (P = .0001, P = .007). No difference in comorbidities, nodes retrieved, extracapsular extension, radiation, hormone therapy, or overall survival was observed. CONCLUSION: In clinically node-negative breast cancer patients, ALND for N1 disease has no impact on short-term recurrence or survival.
BACKGROUND: American College of Surgeons Oncology Group Z0011 trial of select node-positive breast cancerpatients demonstrated no survival or recurrence differences between SLN/axillary lymph node dissection (ALND) vs SLN. Our comparable node-positive lumpectomy and mastectomy populations should have similar outcomes. METHODS: An Institutional Review Board approved, retrospective review of pathologic SLN (N1) cases was performed. Treatment, recurrence, and survival were collected. Statistics was analyzed via exact chi-square test with Monte Carlo estimation, Kaplan-Meier curves, and log-rank tests. RESULTS: Of 528 node-positive patients, 318 patients met criteria: 28 (21.7%) lumpectomy, 32 (16.9%) mastectomy had SLN; 101 (78.2%) lumpectomy, 157 (83.0%) mastectomy had SLN + ALND. Median age was 57.5 years for SLN and 53 years for SLN + ALND (P = .003). Mean positive nodes were 1.1 for SLN and 1.47 for SLN + ALND (P = .0018). Chemotherapy use differed (SLN = 73.5%, SLN + ALND = 89.7%, P = .0032). Stage and recurrence were higher for SLN + ALND (P = .0001, P = .007). No difference in comorbidities, nodes retrieved, extracapsular extension, radiation, hormone therapy, or overall survival was observed. CONCLUSION: In clinically node-negative breast cancerpatients, ALND for N1 disease has no impact on short-term recurrence or survival.
Authors: Elizabeth FitzSullivan; Roland L Bassett; Henry M Kuerer; Elizabeth A Mittendorf; Min Yi; Kelly K Hunt; Gildy V Babiera; Abigail S Caudle; Dalliah M Black; Isabelle Bedrosian; Chantal Reyna; Mediget Teshome; Funda Meric-Bernstam; Rosa Hwang Journal: Ann Surg Oncol Date: 2016-10-03 Impact factor: 5.344