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. 2023 Feb;12(4):4023-4032.
doi: 10.1002/cam4.5257. Epub 2022 Sep 20.

The need to tailor the omission of axillary lymph node dissection to patients with good prognosis and sentinel node micro-metastases

Gilles Houvenaeghel  1 , Alexandre de Nonneville  2 , Nicolas Chopin  3 , Jean-Marc Classe  4 , Chafika Mazouni  5 , Marie-Pierre Chauvet  6 , Fabien Reyal  7 , Christine Tunon de Lara  8 , Eva Jouve  9 , Roman Rouzier  10 , Emile Daraï  11 , Pierre Gimbergues  12 , Charles Coutant  13 , Anne Sophie Azuar  14 , Richard Villet  15 , Patrice Crochet  16 , Sandrine Rua  1 , Marie Bannier  1 , Monique Cohen  1 , Jean-Marie Boher  17
Affiliations

The need to tailor the omission of axillary lymph node dissection to patients with good prognosis and sentinel node micro-metastases

Gilles Houvenaeghel et al. Cancer Med. 2023 Feb.

Abstract

Background: Results of IBCSG-23-01-trial which included breast cancer patients with involved sentinel nodes (SN) by isolated-tumor-cells or micro-metastases supported the non-inferiority of completion axillary-lymph-node-dissection (cALND) omission. However, current data are considered insufficient to avoid cALND for all patients with SN-micro-metastases.

Methods: To investigate the impact of cALND omission on disease-free-survival (DFS) and overall survival (OS), we analyzed a cohort of 1421 patients <75 years old with SN-micro-metastases who underwent breast conservative surgery (BCS). We used inverse probability of treatment weighting (IPTW) to obtain adjusted Kaplan-Meier estimators representing the experience in the analysis cohort, based on whether all or none had been subject to cALND omission.

Results: Weighted log-rank tests comparing adjusted Kaplan-Meier survival curves showed significant differences in OS (p-value = 0.002) and borderline significant differences in DFS (p-value = 0.090) between cALND omission versus cALND. Cox's regression using stabilized IPTW evidenced an average increase in the risk of death associated with cALND omission (HR = 2.77, CI95% = 1.36-5.66). Subgroup analyses suggest that the rates of recurrence and death associated with cALND omission increase substantially after a large period of time in the half sample of women less likely to miss cALND.

Conclusions: Using IPTW to estimate the causal treatment effect of cALND in a large retrospective cohort, we concluded cALND omission is associated with an increased risk of recurrence and death in women of <75 years old treated by BCS in the absence of a large consensus in favor of omitting cALND. These results are particularly contributive for patients treated by BCS where cALND omission rates increase over time.

Trial registration: ClinicalTrials.gov NCT03461172.

Keywords: adjusted Kaplan-Meier estimator; axillary lymph node dissection; breast cancer; micro-metastasis; sentinel node.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Adjusted Kaplan–Meier estimates for overall survival according to completion axillary lymph node dissection (cALND) or no cALND
FIGURE 2
FIGURE 2
Adjusted Kaplan–Meier estimates for disease‐free survival according to completion axillary lymph node dissection (cALND) or no cALND
FIGURE 3
FIGURE 3
(A) Adjusted Kaplan–Meier estimates for DFS and OS according to completion axillary lymph node dissection (cALND) or no cALND: BCS sub‐cohort with ps < = 0.13. (B) Adjusted Kaplan–Meier estimates for DFS and OS according to completion axillary lymph node dissection (cALND) or no cALND: BCS sub‐cohort with ps > 0.13.
See this image and copyright information in PMC

References

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