Patients with early breast cancer benefit from effective axillary treatment

Harris, Jay R.; Osteen, Robert T.

doi:10.1007/bf01807645

Cited by 155 publications

(55 citation statements)

References 11 publications

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“…However, Gardner argued that B-04 and other studies lacked sufficient statistical power to confirm survival advantage from AD (Gardner, 1993). Furthermore, Harris and Osteen proposed that 35% of the patients in the control arm of B-04 actually had a limited axillary dissection, which might have hidden a small survival advantage (Harris, 1985). Moreover several clinical studies demonstrated that the incidence of axillary recurrence was very high (ranging from18 to 35%), when clinically negative axillary nodes in old woman were observed without axillary dissection or radiotherapy (Lythgoe, 1982;Fisher et al, 1985;Ribeiro et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

Is Axillary Dissection Necessary for Breast Cancer in Old Women? A Meta-analysis of Randomized Clinical Trials

Zhang¹,

Chong²,

Zhao³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: We performed this meta-analysis to assess the effectiveness and safety of axillary dissection in old women. Methods: The Cochrane Library, PubMed, EMBASE and Chinese Biomedical Literature Database were searched and all randomized controlled trials of axillary dissection in old women (at least 60 years old) were considered. Meta-analyses were completed using RevMan5.1. Results: Three eligible randomized controlled trials (RCTs) including 5,337 patients were considered. There was weak evidence in favour of axillary dissection (AD) in old women. The meta-analysis showed that the overall survival (OS) after 1, 3, 5 and 7 years and the disease free survival (DFS) after 1, 3 and 5 year were not statistically significantly different between AD and no AD groups. However, there was a difference in the 7 year DFS. Conclusions: Axillary dissection did not provide survival benefit to the old women with breast cancer analysed. Therefore, axillary dissection is not well-indicated in old women with breast cancer.

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Section: Introductionmentioning

confidence: 99%

Is Axillary Dissection Necessary for Breast Cancer in Old Women? A Meta-analysis of Randomized Clinical Trials

Zhang¹,

Chong²,

Zhao³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…It appears that given the number of patients enrolled and the number of events, the study would not have been able to show an absolute survival difference below 5% to 10%. 2,3 Five other clinical trials in which patients were randomized to undergo axillary resection or observation also revealed a higher observed survival number in the axillary resection group. The reported increase in survival of the AD group ranged from 4% to 16%.…”

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confidence: 97%

Breast Cancer Survival According to Number of Nodes Removed

Krag

Single

2003

Ann Surg Oncol

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Background:Results from randomized trials indicate a 5.4% survival advantage associated with axillary dissection. To gain insight on survival outcomes when less than an axillary dissection is performed, we performed a retrospective analysis to determine survival outcome for node-negative and node-positive breast cancer patients when a variable number of nodes were excised.Methods: The data analyzed in this paper are from the Surveillance, Epidemiology, and End Results (SEER) database, from which 72,102 patients were selected whose breast cancer had been diagnosed in 1988 or later and who were aged 40 -79 years at diagnosis, had a single primary lesion, and had 0 to 3 positive lymph nodes. Cases were separated into age groups (40 to 49 and 50 to 79 years), and node-negative cases were separated from those with one to three positive nodes.Results: This analysis indicates that even when all regional lymph nodes are pathologically negative, the number of nodes removed is associated with survival. In the group of breast cancer patients who had one to three pathologically positive nodes, as with the node-negative group, the higher the number of nodes removed, the greater the survival. The hazard rate for death in the node-negative group was roughly 5% less for each additional five nodes removed. For the node-positive group, the hazard rate for death was between 8% and 9% less for each additional five nodes removed.Conclusions: This retrospective study supports the notion that removal of regional nodes, even when such nodes are interpreted as pathologically negative, is important for the long-term survival of breast cancer patients.

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“…The rationales for ALND are the exact staging and prognosis, the regional control in the axilla and the possibility of survival improvement (Fisher et al, 1980;Harris and Osteen, 1985;Petrek and Blackwood, 1995). The extent of the axillary lymph node involvement is one of the most important independent prognostic factors for recurrence and survival in patients with invasive breast cancer (Carter et al, 1989;Rosen et al, 1989Rosen et al, , 1993Rosen and Groshen, 1990;NIH Consensus Conference, 1991;Mustafa et al, 1998).…”

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confidence: 99%

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Reitsamer

Peintinger²,

Prokop

et al. 2004

Br J Cancer

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The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V s ) and technetium 99m-labelled albumin (Nanocoll s ). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLNnegative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.

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Patients with early breast cancer benefit from effective axillary treatment

Cited by 155 publications

References 11 publications

Is Axillary Dissection Necessary for Breast Cancer in Old Women? A Meta-analysis of Randomized Clinical Trials

Is Axillary Dissection Necessary for Breast Cancer in Old Women? A Meta-analysis of Randomized Clinical Trials

Breast Cancer Survival According to Number of Nodes Removed

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

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