title: Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes.
abstract: Omission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion.
  
  
  
  A retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts.
  
  
  
  Among 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36-4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74-2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46-5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90-2.73).
  
  
  
  A separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, France. Electronic address: g.houvenaeghel@orange.fr.
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Boher
authors.affiliation: Institut Curie, 26 rue d'Ulm, 75248, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Reyal
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France.
authors.forename: J R
authors.initials: JR
authors.lastname: Garbay
authors.affiliation: Institut René Gauducheau, Site hospitalier Nord, St Herblain, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Centre René Huguenin, 35 rue Dailly, Saint Cloud, France.
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Giard
authors.affiliation: Centre Léon Bérard, 28 rue Laennec, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Faure
authors.affiliation: Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France.
authors.forename: H
authors.initials: H
authors.lastname: Charitansky
authors.affiliation: Institut Bergonié, 229 Cours de l'Argonne, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Tunon de Lara
authors.affiliation: Hôpital Tenon, 4 rue de la Chine, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France.
authors.forename: D
authors.initials: D
authors.lastname: Hudry
authors.affiliation: Hôpital de Grasse, Chemin de Clavary, Grasse, France.
authors.forename: P
authors.initials: P
authors.lastname: Azuar
authors.affiliation: Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France.
authors.forename: P
authors.initials: P
authors.lastname: Gimbergues
authors.affiliation: Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Villet
authors.affiliation: Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Sfumato
authors.affiliation: Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Lambaudie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D015996:Survival Rate; D055815:Young Adult
keywords: Axillary lymph node dissection; Breast cancer; Isolated tumour cells; Micrometastases; Sentinel node