Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes. (November 2016)

• Record Type: Journal Article
• Authors: Houvenaeghel, G.; Boher, J.M.; Reyal, F.; Cohen, M.; Garbay, J.R.; Classe, J.M.; Rouzier, R.; Giard, S.; Faure, C.; Charitansky, H.; Tunon de Lara, C.; Daraï, E.; Hudry, D.; Azuar, P.; Gimbergues, P.; Villet, R.; Sfumato, P.; Lambaudie, E.
• Is Part Of: European journal of cancer. Volume 67(2016)
• Page Start: 106
• Page End: 118
• Publication Date: 2016-11
• Subjects: Axillary lymph node dissection -- Breast cancer -- Sentinel node -- Micrometastases -- Isolated tumour cells; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2016.08.003
• Languages: English
• ISSNs: 0959-8049

Abstract

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. Highlights: Impact of axillary lymph node dissection (ALND) omission in 2009 patients with breast cancer, micrometastases (Mic) or isolated tumour cells (ITCs) in sentinel node was analysed. Patients with ALND were matched to patients with and without ALND for Mic and ITC subgroups. The increased risk of death and recurrence with ALND omission was found in the Mic cohort (respectively, hazard ratio 2.88 and 1.56). The non-inferiority of axillary lymph node dissection omission in breast cancer with sentinel node micrometastases is not demonstrated.