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Updated: Dec 24, 2025

Influence of Emotional Factors on the Efficacy of Acupuncture Treatment for Overweight Complicated with Hyperlipidemia: A Retrospective Cohort Study
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Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database.

Jiwoong Jung1, Byoung Hyuck Kim2, Jongjin Kim3

  • 1Department of Surgery, Seoul Medical Center, Seoul 02053, Korea.

Cancers
|April 16, 2020
PubMed
Summary

Axillary lymph node dissection (ALND) can be omitted for breast cancer patients with 1-2 metastatic sentinel lymph nodes, validating the Z0011 trial. Outcomes were similar whether or not ALND was performed after sentinel lymph node dissection.

Keywords:
axillary lymph node dissectionbreast cancersentinel lymph node biopsy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Clinical Trials

Background:

  • The Z0011 trial suggested omitting axillary lymph node dissection (ALND) in specific breast cancer cases.
  • Validation of these findings in a larger, population-based cohort is crucial for clinical practice guidelines.

Purpose of the Study:

  • To validate the Z0011 trial's findings on omitting axillary lymph node dissection (ALND).
  • To compare breast cancer-specific mortality (BCSM) between patients who underwent sentinel lymph node dissection (SLND) alone versus SLND plus ALND.

Main Methods:

  • Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015).
  • Patients comparable to Z0011 trial participants were identified.
  • Axillary surgery type was inferred by the number of examined axillary lymph nodes (ALNs).
  • Propensity-score matching was used to compare BCSM between groups (≥10 ALNs vs. 1-2 ALNs).

Main Results:

  • 7077 patients in the SLND group (1-2 ALNs) and 6620 in the SLND + ALND group (≥10 ALNs) were analyzed.
  • After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group versus the SLND + ALND group was 1.038 (95% CI: 0.798-1.350).
  • No significant difference in BCSM was observed between the groups, regardless of the SLND criteria.

Conclusions:

  • Axillary lymph node dissection (ALND) can be safely omitted in breast cancer patients with 1-2 positive sentinel lymph nodes, supporting the Z0011 trial strategy.
  • Population-based data validate that omitting ALND does not negatively impact breast cancer-specific survival.
  • These findings reinforce the potential to reduce surgical morbidity by avoiding unnecessary ALND in selected patients.