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. 2024 Jul 26;16(15):2666.
doi: 10.3390/cancers16152666.

Omission of Completion Axillary Lymph Node Dissection for Patients with Breast Cancer Treated by Upfront Mastectomy and Sentinel Node Isolated Tumor Cells or Micrometastases

Gilles Houvenaeghel  1 , Mellie Heinemann  2 , Jean-Marc Classe  3 , Catherine Bouteille  4 , Pierre Gimbergues  5 , Anne-Sophie Azuar  6 , Marc Martino  7 , Agnès Tallet  8 , Monique Cohen  4 , Alexandre de Nonneville  9
Affiliations

Omission of Completion Axillary Lymph Node Dissection for Patients with Breast Cancer Treated by Upfront Mastectomy and Sentinel Node Isolated Tumor Cells or Micrometastases

Gilles Houvenaeghel et al. Cancers (Basel). .

Abstract

Omission of completion axillary lymph node dissection (cALND) in patients undergoing mastectomy with sentinel node (SN) isolated tumor cells (ITC) or micrometastases is debated due to potential under-treatment, with non-sentinel node (NSN) involvement detected in 7% to 18% of patients. This study evaluated the survival impact of cALND omission in a cohort of breast cancer (BC) patients treated by mastectomy with SN ITC or micrometastases. Among 554 early BC patients (391 pN1mi, 163 ITC), the NSN involvement rate was 13.2% (49/371). With a median follow-up of 66.46 months, multivariate analysis revealed significant associations between cALND omission and overall survival (OS, HR: 2.583, p = 0.043), disease-free survival (DFS, HR: 2.538, p = 0.008), and metastasis-free survival (MFS, HR: 2.756, p = 0.014). For Her2-positive or triple-negative patients, DFS was significantly affected by cALND omission (HR: 38.451, p = 0.030). In ER-positive Her2-negative BC, DFS, OS, recurrence-free survival (RFS), and MFS were significantly associated with cALND omission (DFS HR: 2.358, p = 0.043; OS HR: 3.317; RFS HR: 2.538; MFS HR: 2.756). For 161 patients aged ≤50 years with ER-positive/Her2-negative cancer, OS and breast cancer-specific survival (BCSS) were notably impacted by cALND omission (OS HR: 103.47, p = 0.004; BCSS HR: 50.874, p = 0.035). These findings suggest a potential negative prognostic impact of cALND omission in patients with SN micrometastases or ITC. Further randomized trials are needed.

Keywords: axillary lymph node dissection; early breast cancer; micrometastases; sentinel lymph node.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Disease-free survival for all patients according to completion axillary lymph node dissection (cALND) or not, in multivariate analysis.
Figure 2
Figure 2
Disease-free survival (DFS) for Her2-positive or triple-negative breast cancer according to completion axillary lymph node dissection (cALND) or not, in multivariate analysis.
Figure 3
Figure 3
Disease-free survival (DFS) for ER-positive Her2-negative breast cancer according to completion axillary lymph node dissection (cALND) or not, in multivariate analysis.
Figure 4
Figure 4
Disease-free survival (DFS) for ER-positive Her2-negative breast cancer patients ≤ 50 years according to completion axillary lymph node dissection (cALND) or not, in multivariate analysis.
See this image and copyright information in PMC

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