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10-Year axillary recurrence in the RACS SNAC1 randomised trial of sentinel lymph node-based management versus routine
Ian Campbell1, Neil Wetzig2, Owen Ung3
1Department of Surgery, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand; Waikato Hospital, Hamilton, New Zealand.
Breast (Edinburgh, Scotland)
|July 2, 2023
Summary
Sentinel node-based management (SNBM) showed higher axillary recurrence (AR) rates than axillary lymph node dissection (ALND) in early breast cancer patients. However, overall survival and breast cancer-specific survival remained similar, supporting SNBM as a treatment choice.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Sentinel node-based management (SNBM) is standard for node-negative early breast cancer.
- Randomized trials show similar outcomes between SNBM and axillary lymph node dissection (ALND).
- This study reports 10-year outcomes for axillary recurrence (AR), overall survival, and breast cancer-specific survival in the SNAC1 trial.
Purpose of the Study:
- To compare 10-year axillary recurrence (AR) rates between sentinel node-based management (SNBM) and axillary lymph node dissection (ALND).
- To evaluate overall survival and breast cancer-specific survival at 10 years for both treatment groups.
- To identify predictors of AR in early breast cancer patients.
Main Methods:
- 1,088 women with clinically node-negative, unifocal breast cancers (≤3 cm) were randomized.
- Groups received either SNBM with ALND if sentinel node (SN) was positive, or SN biopsy followed by ALND regardless of SN status.
- Follow-up included assessment of AR, disease-free survival, breast cancer-specific survival, and overall survival at 10 years.
Main Results:
- First ARs were significantly more frequent with SNBM (1.85%) compared to ALND (0.37%) at 10 years (HR 5.47, p=0.013).
- Disease-free survival, breast cancer-specific survival, and overall survival were similar between SNBM and ALND groups.
- Lymphovascular invasion was a significant independent predictor of AR (HR 6.6, p<0.001).
Conclusions:
- SNBM demonstrated a higher frequency of first ARs than ALND in women with small, unifocal breast cancers.
- The absolute AR rate was low in eligible patients, supporting SNBM as the treatment of choice.
- Further research is needed for higher-risk breast cancers, as AR risk may influence surgical decisions.
