Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes |
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| Institution: | 1. Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France;2. Institut Curie, 26 rue d’Ulm, 75248, Paris, France;3. Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France;4. Institut René Gauducheau, Site hospitalier Nord, St Herblain, France;5. Centre René Huguenin, 35 rue Dailly, Saint Cloud, France;6. Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France;7. Centre Léon Bérard, 28 rue Laennec, Lyon, France;8. Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France;9. Institut Bergonié, 229 Cours de l’Argonne, Bordeaux, France;10. Hôpital Tenon, 4 rue de la Chine, Paris, France;11. Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France;12. Hôpital de Grasse, Chemin de Clavary, Grasse, France;13. Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France;14. Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France;15. Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France;p. Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France;q. Aix Marseille Université, France;1. Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;2. Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;3. Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;1. Department of Sarcoma and General Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom;2. Department of Medical Statistics, The University of Birmingham, United Kingdom;3. Department of Hepatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, United Kingdom;4. Department of Hepatology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom;1. NUST School of Electrical Engineering and Computer Science, Islamabad, Pakistan;2. University of Oxford, UK;3. Victoria University, Melbourne, Australia;4. University of the West of England, Bristol, UK;1. Austrian Institute of Technology, Giefinggasse 2, 1210, Vienna, Austria;2. Department of Engineering, Aarhus University, Inge Lehmanns Gade 10, DK-8000, Aarhus, Denmark;1. Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010, USA;2. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA |
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| Abstract: | BackgroundOmission 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.MethodsA 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.FindingsAmong 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).InterpretationA 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. |
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| Keywords: | Axillary lymph node dissection Breast cancer Sentinel node Micrometastases Isolated tumour cells |
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