Omission of axillary staging in elderly patients with early stage breast cancer impacts regional control but not survival: A systematic review and meta-analysis. Issue 2 (March 2017) - Liang, Shuyin
Abstract: Introduction: Management of early breast cancer in the elderly population is challenging due to different breast cancer biology and limited tolerance to aggressive treatments. The aim of this study is to evaluate whether the omission of axillary staging impacts breast cancer outcomes in elderly patients. Patients and Methods: A systematic review and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The electronic databases were searched in August 2014 using the following inclusion criteria: Population Elderly patients (≥ 70 years) with early stage (T1/T2, N0) breast cancer. Intervention Axillary staging with a sentinel node biopsy, axillary sampling or axillary node dissection. Control No axillary surgery. Outcomes Local-regional recurrence, disease-free survival, overall survival. Study design RCTs. Results: Two RCTs met the eligibility criteria and were included. A meta-analysis of the included RCTs of 692 patients found that axillary staging reduced the risk of axillary recurrence compared to no axillary staging (RR 0.24, 95% CI: 0.06 to 0.95, I 2 = 0%, p = 0.04). There were no differences observed in in-breast recurrence or distant recurrence (RR 1.20, 95% CI: 0.55 to 2.64, I 2 = 62%, p = 0.65, RR 1.17, 95% CI: 0.75 to 1.82, I 2 = 0%, p = 0.48, respectively). There were no differences observed in overall or breast-cancer specific mortality (RR 0.99, 95% CI: 0.79 to 1.24, I 2 = 0%, p = 0.92, RR 1.07, 95% CI: 0.72 to 1.57, I 2 = 0%, p = 0.75, respectively). Discussion: Omission of axillary staging in elderly patients with clinically negative axillae results in increased regional recurrence but does not appear to impact survival.