ACOSOG Z-0011 criteria impact on axillary surgery for early breast cancer in clinical practice: Evaluation in a retrospective cohort of 1900 patients

Dolivet, Enora; Loaec, Cécile; Johnson, Alison; Renaudeau, Céline; Boiffard, Florence; Dravet, F.; Meflah, Victoire Brillaud; Classe, Jean‐Marc

doi:10.1016/j.ejogrb.2021.04.003

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…Following the NSABP-B-32 trial, the IBCSG 23-01 trial recently provided evidence that SLNB alone, without complete ALND, could be extended to early-stage breast cancer patients presenting only micrometastasis in the sentinel lymph node ( 15 ), and the ACOSOG-Z011 trial demonstrated that ALND was probably not necessary for female breast cancer with SLN micrometastases ( 16 – 18 ). An analysis of studies using the National Cancer Data Base (NCDB) and a prospective, randomized clinical trial (AATRM 048/13/2000) also came to the same conclusion that SLNB with complete ALND did not appear to be associated with a significant improvement in survival in SLN micrometastases ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer: A competing risk analysis using the SEER database

Zhou

Jiang

et al. 2022

Front. Oncol.

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BackgroundSentinel lymph node (SLN) biopsy has been widely recognized as an excellent surgical and staging procedure for early-stage breast cancer, and its development has greatly improved the detection of micrometastases. However, the axillary treatment of micrometastasis has been the subject of much debate.MethodsWe identified 427,131 women diagnosed with breast cancer from 2010 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients whose nodal status was micrometastases (pTxN1miM0) were classified into two groups: the SLNB only group and SLNB with complete ALND group, and we used these classifications to carry out propensity-score matching (PSM) analysis. The primary and secondary endpoints were OS and BCSS, respectively. We then implemented the Kaplan-Meier method and Cox proportional hazard model and used Fine and Gray competitive risk regression to identify factors associated with the risk of all-cause mortality.ResultsAfter the PSM, 1,833 pairs were included in total. The SLNB with complete ALND showed no significant difference in OS (HR=1.04, 95% CI: 0.84-1.28, P=0.73) or BCSS (HR= 1.03, 95% CI: 0.79-1.35, P=0.82) compared to the SLNB only group, and axillary treatment was not associated with breast cancer-specific death (BCSD) (HR=1.13, 95% CI: 0.86-1.48, P=0.400) or other cause-specific death (OCSD) (HR=0.98, 95% CI:0.70-1.38, P=0.920). There was no statistically significant difference in the cumulative incidence of BCSD (Grey’s test, P=0.819) or OCSD (Grey’s test, P=0.788) for between the two groups either. For different molecular subtypes, patients in the SLNB only group showed no statistically significant differences from those in the SLNB with complete ALND group with Luminal A (HR=1.00, 95% CI:0.76-1.32, P=0.98) or Luminal B (HR=0.82, 95% CI:0.42-1.62, P=0.55) but similar OS to HER2-enriched (HR=1.58, 95% CI:0.81-3.07, P=0.19) or triple negative breast cancers (HR=1.18, 95% CI:0.76-1.81, P=0.46).ConclusionsOur results suggest that in early breast cancer patients with micrometastasis, complete ALND does not seem to be required and that SLNB suffices to control locoregional and distant disease, with no significant adverse effects on survival compared to complete ALND.

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Section: Introductionmentioning

confidence: 99%

The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer: A competing risk analysis using the SEER database

Zhou

Jiang

et al. 2022

Front. Oncol.

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The Prognostic Significance of Further Axillary Dissection for Sentinel Lymph Node Micrometastases in Female Breast Cancer: A Competing Risk Analysis using the SEER Database

Zhou

Jiang

et al. 2022

Preprint

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On the basis of the Surveillance, Epidemiology, and End Results (SEER) database, the aim of this study is to identify whether complete axillary lymph node dissection (ALND) is actually required and has an impact on breast cancer-specific survival (BCSS) and overall survival (OS) in breast cancer patients with micrometastases. We identified 13,848 women whose nodal status was micrometastases (pTxN1miM0) were classified into two groups: the sentinel lymph node biopsy (SLNB) only group and SLNB with complete ALND group. After the PSM, we found that the SLNB with complete ALND showed no significant difference in OS (HR = 1.04, 95% CI: 0.84–1.28, P = 0.73) or BCSS (HR = 1.03, 95% CI: 0.79–1.35, P = 0.82) compared to the SLNB only group. There was no statistically significant difference in the cumulative incidence of BCSD (Grey’s test, P = 0.819) or OCSD (Grey’s test, P = 0.788) for between the two groups either. Our results suggest that in early breast cancer patients with micrometastasis, complete ALND does not seem to be required and that SLNB suffices to control locoregional and distant disease, with no significant adverse effects on survival compared to complete ALND.

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ACOSOG Z-0011 criteria impact on axillary surgery for early breast cancer in clinical practice: Evaluation in a retrospective cohort of 1900 patients

Cited by 2 publications

References 18 publications

The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer: A competing risk analysis using the SEER database

The prognostic significance of further axillary dissection for sentinel lymph node micrometastases in female breast cancer: A competing risk analysis using the SEER database

The Prognostic Significance of Further Axillary Dissection for Sentinel Lymph Node Micrometastases in Female Breast Cancer: A Competing Risk Analysis using the SEER Database

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