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Axillary Lymph Node Dissection is Associated with Improved Survival Among Men with Invasive Breast Cancer and
Sophie H Chung1, Susanna W L de Geus1, Grant Shewmaker1
1Department of Surgery, Section of Surgical Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Annals of Surgical Oncology
|May 19, 2023
Summary
Axillary dissection (ALND) improved survival in men with early-stage male breast cancer (MBC) and positive sentinel lymph nodes compared to sentinel lymph node biopsy (SLNB) alone. These findings suggest current guidelines for women may not apply to men with MBC.
Area of Science:
- Oncology
- Surgical Oncology
- Clinical Research
Background:
- Male breast cancer (MBC) management often relies on data from female breast cancer trials.
- The applicability of contemporary axillary management strategies, based on female patient data, to male patients remains uncertain.
- Limited evidence exists regarding the optimal axillary staging for men with early-stage breast cancer and positive sentinel lymph nodes.
Purpose of the Study:
- To compare survival outcomes between complete axillary dissection (ALND) and sentinel lymph node biopsy (SLNB) alone in men with early-stage male breast cancer and positive sentinel lymph nodes.
- To investigate factors associated with the choice between ALND and SLNB in this patient population.
- To determine if findings from landmark trials in women (e.g., ACOSOG Z0011, EORTC AMAROS) are applicable to male breast cancer management.
Main Methods:
- Retrospective analysis of the National Cancer Database (2010-2020) for male patients with clinically node-negative, T1-T2 breast cancer and 1-2 positive sentinel lymph nodes.
- Utilized 1:1 propensity score matching and multivariate regression to control for confounding variables between SLNB and ALND groups.
- Kaplan-Meier methods were employed to compare overall survival between the two treatment arms.
Main Results:
- A cohort of 1203 male breast cancer patients was analyzed; 61.1% underwent SLNB and 38.9% underwent ALND.
- Factors associated with higher likelihood of ALND included treatment at academic centers, having 2 positive lymph nodes on SLNB, and receiving or being recommended for chemotherapy.
- After propensity score matching, ALND was associated with significantly superior 5-year overall survival (83.8%) compared to SLNB alone (76.0%; log-rank p = 0.0104).
Conclusions:
- In early-stage male breast cancer with limited sentinel lymph node metastasis, axillary lymph node dissection (ALND) demonstrates superior survival outcomes compared to sentinel lymph node biopsy (SLNB) alone.
- Extrapolation of findings from female-focused trials like ACOSOG Z0011 and EORTC AMAROS to male breast cancer may be inappropriate.
- These results highlight the need for distinct management considerations for axillary staging in male breast cancer patients.
