Outcomes with and without axillary node dissection for node-positive lumpectomy and mastectomy patients

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• The Z0011 trial indicated no survival or recurrence differences between sentinel lymph node biopsy (SLN) and axillary lymph node dissection (ALND) in select node-positive breast cancer patients.
• This study aimed to validate these findings in comparable lumpectomy and mastectomy patient cohorts.

Purpose of the Study:

• To evaluate the impact of axillary lymph node dissection (ALND) in addition to sentinel lymph node biopsy (SLN) on recurrence and survival in node-positive breast cancer patients.
• To determine if ALND provides additional benefit beyond SLN for patients with N1 disease.

Main Methods:

• Retrospective review of 318 node-positive breast cancer patients (N1 disease) who underwent SLN biopsy, with or without ALND.
• Statistical analysis included chi-square tests, Kaplan-Meier curves, and log-rank tests to compare outcomes between SLN and SLN + ALND groups.

Main Results:

• No significant differences in overall survival were observed between patients who had SLN alone versus SLN + ALND.
• Higher rates of chemotherapy use and recurrence were noted in the SLN + ALND group compared to the SLN-only group.
• No differences in comorbidities, nodes retrieved, extracapsular extension, radiation, or hormone therapy were found between the groups.

Conclusions:

• Axillary lymph node dissection (ALND) does not improve short-term recurrence or survival outcomes for clinically node-negative breast cancer patients with N1 disease.
• Omitting ALND in favor of SLN alone may be a safe and effective approach for select node-positive breast cancer patients.