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Omission of Completion Axillary Lymph Node Dissection for Patients with Breast Cancer Treated by Upfront Mastectomy and Sentinel Node Isolated Tumor Cells or Micrometastases.
Houvenaeghel, Gilles; Heinemann, Mellie; Classe, Jean-Marc; Bouteille, Catherine; Gimbergues, Pierre; Azuar, Anne-Sophie; Martino, Marc; Tallet, Agnès; Cohen, Monique; de Nonneville, Alexandre.
Afiliação
  • Houvenaeghel G; Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, 13009 Marseille, France.
  • Heinemann M; Centre Léon Bérard, 28 rue Laennec, 69673 Lyon, France.
  • Classe JM; Institut René Gauducheau, Site Hospitalier Nord, 44800 St Herblain, France.
  • Bouteille C; Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, 13009 Marseille, France.
  • Gimbergues P; Centre Jean Perrin, 58 rue Montalembert, 63003 Clermont Ferrand, France.
  • Azuar AS; Hôpital de Grasse, Chemin de Clavary, 06130 Grasse, France.
  • Martino M; Hôpital Saint Joseph, 26 Bd de Louvain, 13008 Marseille, France.
  • Tallet A; Institut Paoli-Calmettes, Department of Radiotherapy, CRCM, 13009 Marseille, France.
  • Cohen M; Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, 13009 Marseille, France.
  • de Nonneville A; Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, 13009 Marseille, France.
Cancers (Basel) ; 16(15)2024 Jul 26.
Article em En | MEDLINE | ID: mdl-39123393
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article