G Houvenaeghel1, J M Boher2, F Reyal3, M Cohen4, J R Garbay5, J M Classe6, R Rouzier7, S Giard8, C Faure9, H Charitansky10, C Tunon de Lara11, E Daraï12, D Hudry13, P Azuar14, P Gimbergues15, R Villet16, P Sfumato2, E Lambaudie4. 1. Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, France. Electronic address: g.houvenaeghel@orange.fr. 2. Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France. 3. Institut Curie, 26 rue d'Ulm, 75248, Paris, France. 4. Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France. 5. Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France. 6. Institut René Gauducheau, Site hospitalier Nord, St Herblain, France. 7. Centre René Huguenin, 35 rue Dailly, Saint Cloud, France. 8. Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France. 9. Centre Léon Bérard, 28 rue Laennec, Lyon, France. 10. Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France. 11. Institut Bergonié, 229 Cours de l'Argonne, Bordeaux, France. 12. Hôpital Tenon, 4 rue de la Chine, Paris, France. 13. Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France. 14. Hôpital de Grasse, Chemin de Clavary, Grasse, France. 15. Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France. 16. Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France.
Abstract
BACKGROUND: Omission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion. METHODS: A retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts. FINDINGS: Among 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36-4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74-2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46-5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90-2.73). INTERPRETATION: A separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
BACKGROUND: Omission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion. METHODS: A retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts. FINDINGS: Among 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36-4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74-2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46-5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90-2.73). INTERPRETATION: A separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
Authors: Hala Halbony; Khadija Salman; Ahmad Alqassieh; Mutaz Albrezat; Ahmad Hamdan; Ali Abualhaija'a; Omar Alsaeidi; Jamal Masad Melhem; Julide Sagiroglu; Orhan Alimoglu Journal: Med J Islam Repub Iran Date: 2020-07-02
Authors: Mausam Patel; Chenghui Li; Julia H Aronson; Cole M Howie; Sanjay Maraboyina; Arpan V Prabhu; Thomas Kim Journal: Breast Date: 2020-03-06 Impact factor: 4.380