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Impact of Axillary Dissection Among Patients With Sentinel Node-Positive Breast Cancer Undergoing Mastectomy
James Sun1, Brittany J Mathias1,2, Christine Laronga1
11Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida.
Journal of the National Comprehensive Cancer Network : JNCCN
|January 6, 2021
Summary
Completion axillary lymph node dissection (CLND) does not impact recurrence or survival for breast cancer patients with positive sentinel lymph node biopsy after mastectomy. Radiotherapy after mastectomy improved survival.
Area of Science:
- Oncology
- Breast Cancer Research
- Surgical Oncology
Background:
- The ACOSOG Z0011 trial suggested omitting completion axillary lymph node dissection (CLND) after breast-conserving surgery with a positive sentinel lymph node biopsy (SLNB).
- This study investigated if CLND impacts outcomes in patients with clinically node-negative (cN0), pathologically node-positive breast cancer undergoing mastectomy.
Purpose of the Study:
- To evaluate the impact of completion axillary lymph node dissection (CLND) on oncologic outcomes in patients with node-positive breast cancer after mastectomy.
- To determine if CLND affects locoregional recurrence, distant recurrence, or overall survival in this patient population.
Main Methods:
- Retrospective review of 329 patients with SLN-positive breast cancer treated between 1999 and 2018.
- Comparison of outcomes between patients who underwent SLNB alone versus SLNB plus CLND.
- Statistical analysis using Kruskal-Wallis, chi-square, Fisher exact, log-rank tests, and Cox proportional hazards models.
Main Results:
- Of 329 patients, 60% (n=201) underwent CLND. Patients receiving CLND had higher tumor grades and more hormone receptor negativity.
- No significant association was found between CLND and overall survival (OS), locoregional, or distant recurrence.
- Completion of postmastectomy radiotherapy was associated with improved OS (P=.04).
Conclusions:
- Completion axillary lymph node dissection (CLND) is not significantly correlated with reduced recurrence or improved OS in cN0, SLN-positive breast cancer patients undergoing mastectomy.
- CLND was significantly correlated with the receipt of adjuvant systemic therapy.
- Postmastectomy radiotherapy completion was associated with improved OS.
