title: Survival impact and predictive factors of axillary recurrence after sentinel biopsy.
abstract: BACKGROUND
  The rate of axillary recurrence (AR) after sentinel lymph node biopsy is usually low but few studies investigated its impact on survival. Our aim was to determine the rate and predictive factors of AR in a large cohort of breast cancer patients and its impact on survival.
  
  
  METHODS
  From 1999 to 2013, 14,095 patients who underwent surgery for clinically N0 previously untreated breast cancer and had sentinel lymph node biopsy were analysed. A simplified score predictive of AR was established.
  
  
  RESULTS
  Median follow-up was 55.2 months. AR was observed in 0.51% of cases, with a median time to onset of 43.4 months. In multivariate analysis, the occurrence of AR was significantly correlated with grade 2 or 3 disease, absence of radiotherapy and tumour subtype (hormonal receptor [HR]- / human estrogen receptor [HER]+). AR rates were 1% for triple-negative tumours, 2.8% for HER2-positive tumours, 0.4% for luminal A tumours, 0.9% for HER2-negative luminal B tumours, and 0.5% for HER2-positive luminal B tumours. A simplified score predictive of the occurrence of AR was established. Patients could be divided into three different score groups (p < 0.0001). In multivariate analysis, overall survival was significantly lower in cases of AR (p < 0.0001), age >50, lymphovascular invasion, grade 3 disease, sentinel node (SN) macrometastases, tumour size >20 mm, absence of chemotherapy and triple-negative phenotype. Survival in patients with AR was significantly lower in case of early-onset (2 years) AR (p = 0.017).
  
  
  CONCLUSIONS
  Isolated AR is more common in Her2-positive/HR-negative triple-negative tumours with a more severe prognosis in triple-negative and Her2-positive/HR-negative tumours, and represents an independent adverse factor justifying an indication for systemic treatment for AR treatment. However, the benefit of any systemic treatment remains to be proven.
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, 13009 Marseille, France; Institut Paoli Calmettes, Biostatistic Department, 232 Bd Ste Marguerite, 13009 Marseille, France; Aix Marseille Université, 25 Bd Jean Moulin, 13005 Marseille, France. Electronic address: g.houvenaeghel@orange.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Institut René Gauducheau, Site hospitalier Nord, Boulevard Professeur Jacques Monod, 44805 St Herblain, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Institut Gustave Roussy, 114 rue Edouard Vaillant, 94800 Villejuif, France.
authors.forename: Jean-Rémy
authors.initials: JR
authors.lastname: Garbay
authors.affiliation: Centre Oscar Lambret, 3 rue Frédéric Combenal, 59000 Lille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Giard
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, 13009 Marseille, France; Institut Paoli Calmettes, Biostatistic Department, 232 Bd Ste Marguerite, 13009 Marseille, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Centre Léon Bérard, 28 rue Laennec, 69373 Lyon, France.
authors.forename: Chistine
authors.initials: C
authors.lastname: Faure
authors.affiliation: Centre Claudius Regaud, 20-24 rue du Pont St Pierre, 31059 Toulouse, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Charytansky
authors.affiliation: Centre René Huguenin, 35 rue Dailly, 92210 Saint Cloud, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000 Dijon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hudry
authors.affiliation: Hôpital de Grasse, Chemin de Clavary, 06130 Grasse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Azuar
authors.affiliation: Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, 75012 Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Villet
authors.affiliation: Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gimbergues
authors.affiliation: Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Tunon de Lara
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, 13009 Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Martino
authors.affiliation: Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000 Dijon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fraisse
authors.affiliation: Institut René Gauducheau, Site hospitalier Nord, Boulevard Professeur Jacques Monod, 44805 St Herblain, France.
authors.forename: François
authors.initials: F
authors.lastname: Dravet
authors.affiliation: Centre Oscar Lambret, 3 rue Frédéric Combenal, 59000 Lille, France.
authors.forename: Marie Pierre
authors.initials: MP
authors.lastname: Chauvet
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, 13009 Marseille, France; Institut Paoli Calmettes, Biostatistic Department, 232 Bd Ste Marguerite, 13009 Marseille, France; Aix Marseille Université, 25 Bd Jean Moulin, 13005 Marseille, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Goncalves
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, 13009 Marseille, France; Institut Paoli Calmettes, Biostatistic Department, 232 Bd Ste Marguerite, 13009 Marseille, France; Aix Marseille Université, 25 Bd Jean Moulin, 13005 Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lambaudie
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005602:France; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D061206:Neoplasm Micrometastasis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D013997:Time Factors; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor
keywords: Axillary recurrence; Breast cancer; Predictive factors; Sentinel lymph node biopsy; Survival