Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy

Lim, Si Ching; Kusumawidjaja, Grace; Ishak, Hanis Mariyah Mohd; Tan, Benita Kiat Tee; Tan, Si Ying; Hamzah, Julie Liana Bte; Madhukumar, Preetha; Yong, Wei Sean; Wong, Chow Yin; Sim, Yirong; Lim, Geok Hoon; Lim, Swee Ho; Tan, Su-Ming; Wong, Fuh Yong; Tan, Veronique Kiak Mien

doi:10.1007/s10549-021-06341-1

Cited by 3 publications

(16 citation statements)

References 13 publications

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“…All included studies were published in English. Twenty-two studies reported overall survival data ( 5 , 7 , 11 , 15 – 27 , 29 , 30 , 32 , 33 , 35 ). Eleven studies reported disease-free survival data ( 5 , 7 , 11 , 15 , 23 , 30 – 35 ).…”

Section: Resultsmentioning

confidence: 99%

Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis

Li,

Zhang,

et al. 2024

Front. Oncol.

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BackgroundThe omission of axillary lymph node dissection (ALND) or axillary radiation (AxRT) remains controversial in patients with clinical node-negative early breast cancer and a positive sentinel lymph node.MethodsWe conducted a comprehensive review by searching PubMed, Embase, Web of Science, and Cochrane databases (up to November 2023). Our primary outcomes were overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and axillary recurrence (AR).ResultsWe included 26 studies encompassing 145,548 women with clinical node-negative early breast cancer and positive sentinel lymph node. Pooled data revealed no significant differences between ALND and sentinel lymph node biopsy (SLNB) alone in terms of OS (hazard ratio [HR]0.99, 95% confidence interval [CI] 0.91-1.08, p=0.84), DFS (HR 1.04, 95% CI 0.90-1.19, p=0.61), LRR (HR 0.76, 95% CI 0.45-1.20, p=0.31), and AR (HR 1.01, 95% CI 0.99-1.03, p=0.35). Similarly, no significant differences were observed between AxRT and SLNB alone for OS (HR 0.57, 95% CI 0.32-1.02, p=0.06) and DFS (HR 0.52, 95% CI 0.26-1.05, p=0.07). When comparing AxRT and ALND, a trend towards higher OS was observed the AxRT group (HR 0.08, 95% CI 0.67-1.15), but the difference did not reach statistical significance (p=0.35, I2 = 0%). Additionally, no significant differences significance observed for DFS or AR (p=0.13 and p=0.73, respectively) between the AxRT and ALND groups.ConclusionOur findings suggest that survival and recurrence rates are not inferior in patients with clinical node-negative early breast cancer and a positive sentinel lymph node who receive SLNB alone compared to those undergoing ALND or AxRT.

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Section: Resultsmentioning

confidence: 99%

Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis

Li,

Zhang,

et al. 2024

Front. Oncol.

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“…A total of 10 retrospective studies [4, 9–12, 22–26] were finally identified through database searches, as illustrated in Fig. 1.…”

Section: Resultsmentioning

confidence: 99%

“…Associations between subsequent ALND and clinicopathological features in mastectomy patients with limited positive SLNs were analyzed in eight studies [4, 9–12, 23–25]. Pooled analyses revealed that subsequent ALND was significantly associated with invasive ductal carcinomas, larger tumor size (> 2 cm), high histological grade, lymphovascular invasion (LVI), negative ER, macrometastatic SLNs (> 2 mm in size), more positive SLNs (> 1), extranodal extension and positive surgical margins ( P < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…The influence of ALND on OS in BC patients who had limited SLN metastases undergoing mastectomy was investigated in eight studies [4, 9–12, 23–25]. No significant correlation between subsequent ALND and longer OS was observed from the pooled result (HR = 0.89, 95% CI 0.75–1.04, P = 0.149), with significant heterogeneity among included studies ( I 2 = 53.5%, P heterogeneity = 0.018) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…There were four studies [9, 10, 25, 26] evaluating the influence of ALND on DFS in BC patients who had limited positive SLNs treated with mastectomy. The pooled analysis indicated that subsequent ALND did not significantly improve DFS compared to SLND only (HR = 1.20, 95% CI 0.74–1.97, P = 0.461), with no significant heterogeneity among included studies ( I 2 = 0.0%, P heterogeneity = 0.922) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Can Axillary Lymph Node Dissection be Omitted in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes Undergoing Mastectomy? A Systematic Review and Meta‐Analysis of Real‐World Evidence

Chen

Lin

et al. 2023

World j. surg.

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Background The omission of axillary lymph node dissection (ALND) in patients with breast cancer who have metastatic sentinel lymph nodes (SLNs) undergoing mastectomy remains controversial. This meta-analysis explored the clinicopathological factors affecting the selection of ALND and the influences of ALND on survival outcomes in patients receiving mastectomy with positive SLNs. Methods Eligible studies published prior to 31 December 2022 were selected by searching the Embase, Web of Science and PubMed databases. Pooled analyses were performed using the number of events for clinicopathological parameters and HRs with 95% CIs for survival outcomes including disease-free survival (DFS), overall survival (OS), distant recurrence-free survival (DRFS) and locoregional recurrence-free survival (LRFS). Results A total of 10 retrospective studies enrolling only breast cancer patients with limited SLN metastases (no more than 3 positive SLNs or micrometastatic SLNs) undergoing mastectomy were included. Performing ALND in mastectomy patients who had limited SLN metastases was significantly correlated with invasive ductal carcinomas, larger tumors, lymphovascular invasion, higher tumor grade, macrometastatic SLNs, more positive SLNs, extranodal extension, positive surgical margins, negative ER, administration of adjuvant chemotherapy and nonwhite race (P \ 0.05). However, performing ALND did not result in significantly longer OS, DFS, LRFS or DRFS (P [ 0.05) in these patients. Conclusion The present meta-analysis indicated that ALND may be safely avoided in patients with breast cancer who had limited SLN metastases undergoing mastectomy. Further well-designed randomized clinical trials are warranted to validate our results.

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Prognosis and local treatment strategies of breast cancer patients with different numbers of micrometastatic lymph nodes

Luo

Lin

et al. 2023

World J Surg Onc

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Background Lymph node micrometastasis is an important prognostic factor in breast cancer, but patients with different numbers of involved lymph nodes are all divided into the same N1mi stage without distinction. We designed this study to compare the prognosis and local treatment recommendations of N1mi breast cancer patients with different numbers of micrometastatic lymph nodes. Patients and methods A total of 27,032 breast cancer patients with T1-2N1miM0 stage from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2019) who underwent breast surgery were included in this retrospective study. Patients were divided into three groups for prognosis comparison according to the number of micrometastatic lymph nodes: N1mi with 1 (Nmi = 1), 2 (Nmi = 2), or more (Nmi ≥ 3) involved lymph nodes. We explored the characteristics and survival outcomes of the population receiving different local treatments, including different axillary surgery types and whether receiving radiotherapy or not. Univariate and multivariate Cox proportional hazards regression analysis were used to compare the overall survival (OS) and breast cancer-specific survival (BCSS) in different groups. Stratified analyses and interaction analyses were also applied to explore the predictive significance of different involved lymph nodes numbers. Propensity score matching (PSM) method was utilized to balance the differences between groups. Results Univariate and multivariate Cox regression analysis indicated that nodal status was an independent prognostic factor. After adjustment for other prognostic factors, there was a significant difference in prognosis between Nmi = 1 group and Nmi = 2 group [adjusted hazard ratio (HR) 1.145, 95% confidence interval (CI): 1.047–1.251, P = 0.003], and patients with Nmi ≥ 3 group had a significantly poorer prognosis (adjusted HR 1.679, 95% CI 1.589–2.407; P < 0.001). The proportion of N1mi patients only underwent sentinel lymph nodes biopsy (SLNB) gradually increased from 2010 (Ptrend < 0.001). After adjusting for other factors, N1mi patients who underwent axillary lymph nodes dissection (ALND) was associated with significant survival benefit than SLNB (adjusted HR 0.932, 95%CI 0.874–0.994; P = 0.033), the same goes for receiving radiotherapy (adjusted HR 1.107, 95%CI 1.030–1.190; P = 0.006). Further stratified analysis showed that in the SLNB subgroup, radiotherapy was associated with a significant survival benefit (HR 1.695, 95%CI 1.534–1.874; P < 0.001), whereas in the ALND subgroup, there was no significant prognostic difference with or without radiotherapy (HR 1.029, 95%CI 0.933–1.136; P = 0.564). Conclusion Our study indicates that the increasing number of lymph node micrometastases was associated a worse prognosis of N1mi breast cancer patients. In addition, ALND does provide a significant survival benefit for these patients, while the benefit from local radiotherapy may be of even greater importance.

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Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy

Cited by 3 publications

References 13 publications

Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis

Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis

Can Axillary Lymph Node Dissection be Omitted in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes Undergoing Mastectomy? A Systematic Review and Meta‐Analysis of Real‐World Evidence

Prognosis and local treatment strategies of breast cancer patients with different numbers of micrometastatic lymph nodes

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