Cancer Res Treat.  2019 Jul;51(3):1011-1021. 10.4143/crt.2018.438.

Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes

• Joo JH
• Kim SS
• Son BH
• Ahn SD
• Jung JH
• Choi EK
• Ahn SH
• Lee JW
• Kim HJ
• Ko BS

• KMID: 2454293
• DOI: http://doi.org/10.4143/crt.2018.438

Abstract

PURPOSE
Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs.
MATERIALS AND METHODS
A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method.
RESULTS
Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months.
CONCLUSION
ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.

Keyword

Breast neoplasms; Mastectomy; Sentinel lymph node biopsy; Lymph node excision; Lymph nodes; Disease-free survival

MeSH Terms

Biopsy
Breast Neoplasms*
Breast*
Disease-Free Survival*
Follow-Up Studies
Humans
Lymph Node Excision*
Lymph Nodes*
Mastectomy
Methods
Neoplasm Metastasis
Recurrence
Sentinel Lymph Node Biopsy

Figure

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  Fig. 1. Patient selection algorithm. SNB, sentinel node biopsy; ALND, axillary lymph node dissection; F/U, follow-up.

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  Fig. 2. Kaplan-Meier survival curves of the total patients. LRRFS, lcoregional recurrence-free survival; DMFS, distant metastasis-free survival; DFS, disease-free survival; OS, overall survival.

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  Fig. 3. Forest plot demonstrating the risks of death, locoregional recurrence, distant metastasis, and disease recurrences for sentinel node biopsy (SNB) relative to axillary lymph node dissection (ALND). HR, hazard ratio; CI, confidence interval; IPTW, inverse probability of treatment weighted.

• 

  Fig. 4. Changes in the number of axillary lymph node dissection (ALND) and sentinel node biopsy (SNB) procedures by year.

Reference

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