"Axillary recurrences after sentinel lymph node biopsy: a multicentre analysis and follow-up of sentinel lymph node negative breast cancer patients".
BACKGROUND
The objective of this study was to conduct a multicentre data analysis to identify prognostic factors for developing an axillary recurrence (AR) after negative sentinel lymph node biopsy (SLNB) in a large cohort of breast cancer patients with long follow-up.


METHODS
The prospective databases from different hospitals of clinically node negative breast cancer patients operated on between, 2000 and 2002 were analyzed. SLNB was performed and pathological analysis done by local pathologists according to national guidelines. Adjuvant treatment was given according to contemporary guidelines. Multivariate analysis was performed using all available variables, a p-value of <0,05 was considered to be significant.


RESULTS
A total of 929 patients who did not undergo axillary lymph node dissection were identified. After a median follow up of 77 (range 1-106) months, fifteen patients developed an isolated AR (AR rate 1,6%). Multivariate analysis showed that young age (p = 0.007) and the absence of radiotherapy (p = 0.010) significantly increased the risk of developing an AR. Distant metastasis free survival (DMFS) was significantly worse for patients with an AR compared to all other breast cancer patients (p < 0,0001).


CONCLUSIONS
Even after long-term follow up, the risk of developing an AR after a negative SLN in breast cancer is low. Young age and absence of radiation therapy are highly significant factors for developing an axillary recurrence. DMFS is worse for AR patients compared to patients initially diagnosed with N0 or N1 disease.
Dep. of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. bobvanwely@yahoo.com
B J
BJ
van Wely
F J H
FJ
van den Wildenberg
P
P
Gobardhan
T
T
van Dalen
I H M
IH
Borel Rinkes
E B M
EB
Theunissen
J H
JH
Wijsman
M
M
Ernst
C C
CC
van der Pol
E V E
EV
Madsen
W J
WJ
Vles
C A P
CA
Wauters
J H W
JH
de Wilt
L J A
LJ
Strobbe
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome