Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs. Materials and Methods A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method. Results Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months. Conclusion ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.
Abstract
Purpose Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs. Materials and Methods A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method. Results Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months. Conclusion ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.
참고문헌 (20)
- Giuliano AE, "Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases : the American College of Surgeons Oncology Group Z0011 randomized trial", Ann Surg, 252, pp.426~432 (2010)
- Giuliano AE, "Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis : a randomized clinical trial", JAMA, 305, pp.569~575 (2011)
- Bilimoria KY, "Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer", J Clin Oncol, 27, pp.2946~2953 (2009)
- Fu Y, "Is axillary lymph node dissection necessary after sentinel lymph node biopsy in patients with mastectomy and pathological N1 breast cancer?", Ann Surg Oncol, 21, pp.4109~4123 (2014)
- Chang JS, "Do recent advances in diagnostic and therapeutic procedures negate the benefit of postmastectomy radiotherapy in N1 patients with a low risk of locoregional recurrence?", Medicine (Baltimore), 94, pp.e1259~ (2015)
- Goldhirsch A, "Thresholds for therapies : highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009", Ann Oncol, 20, pp.1319~1329 (2009)
- Austin PC, "Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies", Stat Med, 34, pp.3661~3679 (2015)
- Yi M, "Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients:experience from the SEER database", Ann Surg Oncol, 17(Suppl 3), pp.343~351 (2010)
- Giuliano AE, "Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial", Ann Surg, 264, pp.413~420 (2016)
- Morrow M, "Axillary Dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers : a prospective validation study of 793 patients", Ann Surg, 266, pp.457~462 (2017)
- Milgrom S, "Characteristics and outcomes of sentinel node-positive breast cancer patients after total mastectomy without axillary-specific treatment", Ann Surg Oncol, 19, pp.3762~3770 (2012)
- Clarke M, "Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival : an overview of the randomised trials", Lancet, 366, pp.2087~2106 (2005)
- EBCTCG(Early Breast Cancer Trialists' Collaborative Group), "Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality : metaanalysis of individual patient data for 8135 women in 22 randomised trials", Lancet, 383, pp.2127~2135 (2014)
- Galimberti V, "Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases(IBCSG 23-01) : a phase 3 randomised controlled trial", Lancet Oncol, 14, pp.297~305 (2013)
- Taghian A, "Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy : results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials", J Clin Oncol, 22, pp.4247~4254 (2004)
- Lai SF, "Locoregional recurrence risk for postmastectomy breast cancer patients with T1-2 and one to three positive lymph nodes receiving modern systemic treatment without radiotherapy", Ann Surg Oncol, 23, pp.3860~3869 (2016)
- Yu JI, "Prognostic modeling in pathologic N1 breast cancer without elective nodal irradiation after current standard systemic management", Clin Breast Cancer, 15, pp.e197~e204 (2015)
- Lohrisch C, "Relationship between tumor location and relapse in 6, 781 women with early invasive breast cancer", J Clin Oncol, 18, pp.2828~2835 (2000)
- Dings PJ, "The prognostic value of lymph node ratio in node-positive breast cancer : a Dutch nationwide population-based study", Ann Surg Oncol, 20, pp.2607~2614 (2013)
- Woodward WA, "Prognostic value of nodal ratios in node-positive breast cancer", J Clin Oncol, 24, pp.2910~2916 (2006)