by Zongchao Gou, Xunxi Lu, Mengting He, Luoting Yu
The Breast: VOLUME 63, P9-15, JUNE
01, 2022
Background
There is a lack of studies examining the long-term trend and
survival of axillary surgery for breast cancer patients with sentinel node
metastasis, especially for the patients with 3–5 node metastases.
Methods
Breast cancer patients with 1–5 sentinel node metastases
from the Surveillance, Epidemiology, and End Results (SEER) database from 2000
to 2016. Our study presented the trend of axillary surgery and assessed the
long-term survival of sentinel lymph node biopsy (SLNB) alone vs axillary lymph
node dissection (ALND) for those patients.
Results
Of the 41,996 patients diagnosed with T1-2 breast
cancer after lumpectomy and radiation included, 34,940 had 1-2 sentinel node
metastases and 7056 had 3-5 sentinel node metastases. The percentage of
patients undergoing SLNB alone increased from 22.4% in 2000 to 81.0% in 2016
for patients with 1–2 sentinel node metastases, and quadrupled from 5.2% in
2009 to 20.6% in 2016 for those with 3–5 sentinel node metastases. Completion
of ALND did not benefit the long-term survival of 1–2 sentinel node metastasis
patients (hazard ratio [HR] = 1.02, P = 0.539), but
improved the long-term survival of 3–5 node metastasis patients
(HR = 0.73, P < 0.001). Subgroup analysis demonstrated
the inferiority of SLNB to ALND in all subgroups of 3–5 sentinel node
metastases.
Conclusion
For patients with T1-2 breast cancer after lumpectomy
and radiation, SLNB alone was an efficient and safe surgical choice for 1–2
sentinel node metastases but not for 3–5 sentinel node metastases. It is worth
noting that for patients with 3–5 node metastasis, the proportion of omitted
ALND quadrupled after 2009.
