Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes: a nationwide study.
We estimated the impact of axillary lymph node dissection (ALND) on the risk of axillary recurrence (AR) and overall survival (OS) in breast cancer patients with micrometastases or isolated tumor cells (ITC) in sentinel nodes. We used the Danish Breast Cancer Cooperative Group (DBCG) database to identify patients with micrometastases or ITC in sentinel nodes following surgery for primary breast cancer between 2002 and 2008. A Cox proportional hazard regression model was developed to assess the hazard ratios (HR) for AR and OS between patients with and without ALND. We identified 2074 patients, of which 240 did not undergo further axillary surgery. The 5-year cumulated incidence for AR was 1.58 %. No significant difference in AR was seen between patients with and without ALND. The age adjusted HR for AR if ALND was omitted was 1.79 (95 % CI 0.41-7.80, P = 0.44) in patients with micrometastases and 2.21 (95 % CI 0.54-8.95, P = 0.27), in patients with ITC after a median follow-up of 6 years and 3 months. There was no significant difference in overall survival between patients with and without ALND, when adjusting for age, co-morbidity, tumor size, histology type, malignancy grade, lymphovascular invasion, hormone receptor status, adjuvant systemic treatment and radiotherapy, with a HR for death if ALND was omitted of 1.21 (95 % CI 0.86-1.69, P = 0.27) in patients with micrometastases and 0.96 (95 % CI 0.57-1.62, P = 0.89) in patients with ITC after a medium follow-up on 8 and 5 years. In this nationwide study, we found a low risk of AR on 1.58 % and we did not find a significantly increased risk of AR if ALND was omitted in patients with micrometastases or ITC in sentinel nodes. Furthermore, no significant difference in overall survival was seen between patients with and without ALND when adjusting for adjuvant treatment.
Department of Breast Surgery, Copenhagen University Hospital, Afs 4124, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark. tft@dadlnet.dk.
Tove Filtenborg
TF
Tvedskov
Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark.
Maj-Britt
MB
Jensen
Department of Clinical Oncology and Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark.
Bent
B
Ejlertsen
Breast Surgery Unit, Department of Surgery, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark.
Peer
P
Christiansen
Department of Pathology, Herlev Hospital, Copenhagen, Denmark.
Eva
E
Balslev
Department of Breast Surgery, Copenhagen University Hospital, Afs 4124, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
Niels
N
Kroman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D061206:Neoplasm Micrometastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D021701:Sentinel Lymph Node Biopsy
D014408:Biomarkers, Tumor
ALND; Breast cancer; Isolated tumor cells; Micrometastases; Sentinel node