A randomized controlled research on treating early breast cancer with axillary lymph node group dissec-tion oriented by sentinel lymph nodes instead of axillary dissection / 中华内分泌外科杂志

ABSTRACT

Objective To research the impact of axillary limph node group dissection oriented by senti-nel lymph nodes instead of axillary dissection on upper limb lymph edema and disease -free survival ( DFS ).Methods We designed a randomized controlled research , which included 205 cases of operatable breast cancer (AJCC 7th:stage I or stage IIa)from Jan.2011 to Jan.2013.Those cases were separated into 2 groups randomly ( random number method ):group A underwent mastectomy ( or lumpectomy ) and axillary group lymphadenectomy oriented by sentinel lymph node biopsy ( SLNB) ( if positive continued for ALND ) while group B underwent mastec-tomy(or lumpectomy)and axillary lymph node dissection(ALND).All patients underwent SLNB by blue dye method and received adjuvant therapy after surgery according to National Comprehensive Cancer Network ( NCCN) guideline and Chinese anti-cancer association guideline .Results There were 101 cases in group A and 104 ca-ses in group B , but 1 case in group A was excluded for false negative of SLN.The midium follow-up was 30 months.There were no significant differences of average age , tumor size, grade, estrogen receptor (ER),proges-terone receptor ( PR) and human epidermal growth factor receptor 2 ( HER2 ) expression between the 2 groups. Group A had a lower frequency of lymph edema than group B (4.0%vs 17.3%,χ2 =9.384,P=0.002), and al-so a milder degree ( mild 2%vs 11.5%,middle 2%vs 3.8%,severe 0%vs 1.9%).There were no significant differences of upper limb sensory disorder (14.0%vs 16.3%,χ2 =0.218,P=0.641), neither of DFS(Log-Rank analysis:3-year average DFS 32.89 months vs 33.72 months,χ2 =0.186,P=0.667;Cox risk model analysis:HR=1.395,P=0.495)between the 2 groups.Conclusion Axillary group lymphadenectomy oriented by SLNB can reduce the happening of lymph edema from ALND and has a comparative effect on DFS as ALND .