Comparison of clinical outcomes between sentinel lymph node biopsy and axillary lymph node dissection in a single-center Z0011-eligible breast cancer cohort

Heein Jo; Eun-Gyeong Lee; Eunjin Song; Jai Hong Han; So-Youn Jung; Han-Sung Kang; Eun Sook Lee; Seeyoun Lee

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자료유형: 학술저널

저자정보: Heein Jo (National Cancer Center) Eun-Gyeong Lee (National Cancer Center) Eunjin Song (National Cancer Center) Jai Hong Han (National Cancer Center) So-Youn Jung (National Cancer Center) Han-Sung Kang (National Cancer Center) Eun Sook Lee (National Cancer Center) Seeyoun Lee (National Cancer Center)

저널정보: 대한종양외과학회 KOREAN JOURNAL OF CLINICAL ONCOLOGY Korean Journal of Clinical Oncology 제16권 제1호

발행연도: 2020.6

수록면: 18 - 24 (7page)

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Purpose: The ACOSOG Z0011 trial has proven the oncological safety of sentinel lymph node biopsy (SLBx) for node negative breast cancer. Accordingly, treatment paradigm including axilla surgery was changed. We retrospectively reviewed breast cancer patients to evaluate the clinical effect of paradigm shift in breast cancer surgery after applying the Z0011 criteria.
Methods: All women who underwent breast-conserving surgery at the National Cancer Center between January 1, 2000, and December 31, 2015, were enrolled and classified according to the Z0011 criteria. The primary endpoint of the study was the disease-free survival rates, and the secondary was the adverse events, especially arm lymphedema.
Results: Total 361 patients were enrolled the study (271 axillary lymph node dissection [ALND] group, 90 SLBx group). After the Z0011 guideline was adopted in our institute, the use of ALND decreased, and lymph node sampling (removing only a few axillary lymph nodes) replaced ALND. The total mean number of retrieved nodes were more in ALND group (13.02) than SLBx group (3.43). However, there was no difference in the mean number of positive nodes between two groups (2.34 in ALND group vs. 1.12 in SLBx group, P=0.001). During follow-up, 25 patients experienced disease recurrence: 22 from the ALND group and three from the SLBx group. All of died seven patients were from the ALND group. The ALND group had more complications than the SLBx group (P=0.02). Arm edema occurred more frequently in the ALND group (29.5%) than in the SLBx group (5.6%), although without statistical significance (P=0.07).
Conclusion: In our study, we concluded that SLBx can be used safely in Z0011-eligible cohort without increased risk of locoregional recurrence. Moreover, we found that omission of ALND is favored to reduce some serious complications such as arm lymphedema.

#Breast neoplasms #Breast cancer lymphedema #Sentinel lymph node biopsy #Breast conserving surgery

참고문헌 (12)

참고문헌 신청

Giuliano AE / 2010 / Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases : the American College of Surgeons Oncology Group Z0011 randomized trial / Ann Surg 252:426~432

Giuliano AE / 2011 / Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis : a randomized clinical trial / JAMA 305:569~575

Giuliano AE / 2017 / Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis : the ACOSOG Z0011(Alliance)randomized clinical trial / JAMA 318:918~926

Tsao MW / 2016 / A population-based study of the effects of a regional guideline for completion axillary lymph node dissection on axillary surgery in patients with breast cancer / Ann Surg Oncol 23:3354~3364

Chung A / 2015 / Applicability of the ACOSOG Z0011 criteria in women with high-risk node-positive breast cancer undergoing breast conserving surgery / Ann Surg Oncol 22:1128~1132

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