10-Year axillary recurrence in the RACS SNAC1 randomised trial of sentinel lymph node-based management versus routine axillary lymph node dissection.

Autor: Campbell I; Department of Surgery, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand; Waikato Hospital, Hamilton, New Zealand. Electronic address: Ian.Campbell@waikatodhb.health.nz., Wetzig N; Princess Alexandra Hospital, Brisbane, Australia., Ung O; Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia., Espinoza D; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia., Farshid G; South Australian Pathology, Royal Adelaide Hospital, Adelaide, Australia., Collins J; University of Melbourne, Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia., Kollias J; Department of Surgery, University of Adelaide, Adelaide, Australia; Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia., Gebski V; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia., Mister R; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia., Simes RJ; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia., Stockler MR; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia., Gill G; Emeritus Professor, University of Adelaide, Adelaide, Australia.
Jazyk: angličtina
Zdroj: Breast (Edinburgh, Scotland) [Breast] 2023 Aug; Vol. 70, pp. 70-75. Date of Electronic Publication: 2023 Jun 23.
DOI: 10.1016/j.breast.2023.06.009
Abstrakt: Background: Sentinel node-based management (SNBM) is the international standard of care for early breast cancer that is clinically node-negative based on randomised trials comparing it with axillary lymph node dissection (ALND) and reporting similar rates of axillary recurrence (AR) without distant disease. We report all ARs, overall survival, and breast cancer-specific survival at 10-years in SNAC1.
Methods: 1.088 women with clinically node-negative, unifocal breast cancers 3 cm or less in diameter were randomly assigned to either SNBM with ALND if the sentinel node (SN) was positive, or to SN biopsy followed by ALND regardless of SN involvement.
Results: First ARs were more frequent in those assigned SNBM rather than ALND (11 events, cumulative risk at 10-years 1·85%, 95% CI 0·95-3.27% versus 2 events, 0·37%, 95% CI 0·08-1·26%; HR 5·47, 95% CI 1·21-24·63; p = 0·013). Disease-free survival, breast cancer-specific survival, and overall survival were similar in those assigned SNBM versus ALND. Lymphovascular invasion was an independent predictor of AR (HR 6·6, 95% CI 2·25-19·36, p < 0·001).
Conclusion: First ARs were more frequent with SNBM than ALND in women with small, unifocal breast cancers when all first axillary events were considered. We recommend that studies of axillary treatment should report all ARs to give an accurate indication of treatment effects. The absolute frequency of AR was low in women meeting our eligibility criteria, and SNBM should remain the treatment of choice in this group. However, for those with higher-risk breast cancers, further study is needed because the estimated risk of AR might alter their choice of axillary surgery.
Competing Interests: Declaration of competing interest ICreports grants from Australian National Health and Medical Research Council, grants from National Breast Cancer Foundation, grants from NZ Cancer Society, grants from Scottswood Trust, New Zealand, non-financial support from Astra Zeneca, during the conduct of the study; personal fees from Guerbet Australia Pty. MS reports grants from Astellas, grants from Amgen, grants from Astra Zeneca, grants from Bayer, grants from Bionomics, grants from Bristol-Myers Squibb, grants from Celgene, grants from Medivation, grants from Merck Sharp & Dohme, grants from Pfizer, grants from Roche, grants from Sanofi, grants from Tilray, outside the submitted work. RS reports grants from National Health and Medical Research Council (Australia), grants from Medical Research Future Fund (Australia), grants from Several Pharmaceutical Companies, outside the submitted work.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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