Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes
| Autor: | J.-R. Garbay, Richard Villet, Monique Cohen, Emile Daraï, Fabien Reyal, Pierre Azuar, S. Giard, J-M Classe, H. Charitansky, Eric Lambaudie, Pierre Gimbergues, Delphine Hudry, Gilles Houvenaeghel, Patrick Sfumato, C. Tunon de Lara, C. Faure, J.M. Boher, Roman Rouzier |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Oncology Cancer Research medicine.medical_specialty Population Breast Neoplasms Kaplan-Meier Estimate Disease-Free Survival Cohort Studies Young Adult 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine Humans Medicine 030212 general & internal medicine education Aged Proportional Hazards Models Retrospective Studies Aged 80 and over education.field_of_study business.industry General surgery Carcinoma Ductal Breast Hazard ratio Axillary Lymph Node Dissection Middle Aged Sentinel node medicine.disease Confidence interval Survival Rate Clinical trial Carcinoma Lobular Neoplasm Micrometastasis 030220 oncology & carcinogenesis Axilla Cohort Lymph Node Excision Female Neoplasm Recurrence Local Sentinel Lymph Node business |
| Zdroj: | European Journal of Cancer. 67:106-118 |
| ISSN: | 0959-8049 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect