title: Impact of axillary dissection in women with invasive breast cancer who do not fit the Z0011 ACOSOG trial because of three or more metastatic sentinel lymph nodes.
abstract: OBJECTIVE
  The objective of this study was to determine the effects of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy alone (SLNB) on the survival of patients with 3 or more metastatic lymph nodes (MLN) in invasive breast cancer.
  
  
  METHODS
  Data of 9521 patients with invasive T1-2M0 breast carcinoma and initial treatment with SLNB completed or not by ALND and 3 or more MLN were extracted from the SEER database. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Overall, 9521 patients were included in the study. SLNB-alone compared with ALND did not result in different overall survival (OS) or specific survival (SS) for patients with 3 or more MLN (p = 0.46 and 0.58, respectively). In subgroup analyses, OS was comparable between SLNB-alone and ALND when patients had only 3 or more than 3 MLN. When patients had 3 MLN, the 5-year SS was significantly better for patients with ALND compared with SLNB-alone: 91.5% and 85.1%, respectively (p = 0.02). The Hazard Ratio (HR) for OS comparing SLNB-alone with ALND adjusting for age, adjuvant radiotherapy, tumor size, estrogen receptor status, grade and tumor type resulted in an HR of 1.05 (95% CI, 0.72-1.54, p = 0.77).
  
  
  CONCLUSIONS
  In conclusion, patients with a T1-T2 invasive breast cancer and at least 3 MLN do not benefit from ALND after SLNB for specific and overall survival, thus limiting ALND to a staging procedure. A subgroup of patients with 3 MLN had a better SS with ALND, possibly due to an under-staging of the SLNB-alone group.
authors.affiliation: Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France.
authors.forename: C
authors.initials: C
authors.lastname: Bonneau
authors.affiliation: Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France; EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles-St-Quentin-en-Yvelines University, France.
authors.forename: D
authors.initials: D
authors.lastname: Hequet
authors.affiliation: Department of Surgical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Estevez
authors.affiliation: Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, France.
authors.forename: N
authors.initials: N
authors.lastname: Pouget
authors.affiliation: Department of Surgical Oncology, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, University of Versailles-Saint-Quentin-en-Yvelines, 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: D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Breast cancer; Lymph node biopsy; Lymph node dissection; Metastatic lymph node; Z0011 ACOSOG trial