title: Association of the number of sentinel lymph nodes harvested with survival in breast cancer.
abstract: OBJECTIVE
  In patients with breast cancer, the association between the number of sentinel lymph node (SLN) removed and survival is poorly known. Our objective was to evaluate this association on disease-specific survival (DSS).
  
  
  METHODS
  Data of 144 517 patients with invasive T1-3M0 breast carcinoma and initial treatment with SLN biopsy were extracted from the SEER database. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  The number of SLNs harvested and the completion of axillary lymph node dissection (ALND) were not associated with DSS improvement for patients without metastatic nodes. After adjustment, patients with three SLNs had a better DSS than did other groups (HR of 0.73 CI 95% [0.60-0.88], p = 0.001). This result was mainly driven by the group of patients with one metastatic LN. When patients had two or more metastatic LNs, there was no difference in DSS according to the number of SLNs or to completion of ALND.
  
  
  CONCLUSIONS
  The number of SLN harvested was associated with DSS. According to DSS, the optimal number of SLNs harvested was three in this large series, thereby calling into question the understaging or undertreatment of SLN biopsy in which only one or two SLNs are harvested but also the therapeutic effect of completion ALND.
authors.affiliation: Department of Surgical Oncology, Institut Curie, University of Versailles-Saint-Quentin-en-Yvelines, 35 rue Dailly, 92220 Saint-Cloud, France. Electronic address: bonneau.claire@voila.fr.
authors.forename: C
authors.initials: C
authors.lastname: Bonneau
authors.affiliation: Department of Gynaecology-Obstetrics and Reproductive Medicine, Hôpitaux Universitaires Paris-Est, Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France. Electronic address: sofiane.bendifallah@yahoo.fr.
authors.forename: S
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Department of Surgical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France. Electronic address: fabien.reyal@curie.fr.
authors.forename: F
authors.initials: F
authors.lastname: Reyal
authors.affiliation: Department of Surgical Oncology, Institut Curie, University of Versailles-Saint-Quentin-en-Yvelines, 35 rue Dailly, 92220 Saint-Cloud, France; EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles-St-Quentin-en-Yvelines University, France. Electronic address: lea.rosssi@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Department of Surgical Oncology, Institut Curie, University of Versailles-Saint-Quentin-en-Yvelines, 35 rue Dailly, 92220 Saint-Cloud, France; EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles-St-Quentin-en-Yvelines University, France. Electronic address: roman.rouzier@curie.fr.
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Axillary lymph node dissection; Axillary nodal staging; Breast cancer; Positive lymph node management; Sentinel lymph node