A multicenter cohort to compare quality of life in breast cancer patients according to sentinel lymph node biopsy (SNLB) or full axillary clearance (AC)

Abstract

9633 Background: This prospective study assessed and compared the impact of surgical technique modalities of breast cancer patients on quality of life (QoL). Methods: A pragmatic prospective multicentric study was opened in five hospitals of the Cote d’Or and Saone et Loire (French provinces). All women undergoing breast surgery as primary treatment were eligible. The EORTC QLQ- C30 and the EORTC QLQ BR 23 questionnaires were used to assess the global health status (GHS), the arm (BRAS) and breast (BRBS) symptoms scales. The QoL was measured before surgery, just after surgery and six and twelve months afterwards. The Kruskal Wallis test was used to compare scores according to the surgical procedure using the Bonferroni correction for multiple contrast comparisons. The Wilcoxon matched-pairs signed rank test was used to compare scores according to the time of measurement. A mixed model analysis of variance for repeated measurements was applied to assess the longitudinal effect of surgical techniques on QoL. Results: Between January 1st 2005 and January 1st 2006, 518 breast cancer patients were included. Two hundred thirty-five underwent AC, 222 patients SNLB, and 61 patients had SLNB with complementary axillary lymph node dissection. Before surgery, GHS (p=0.7807), BRAS (p=0.7688) and BRBS (p=0.3007) QoL scores were similar whatever the surgical procedure. As compared to other surgical groups, GHS 75.91(SD=17.44) and BRAS 11.39 (SD=15.36) were better in the SNLB group 12 months after surgery. Whatever surgery type, GHS decreased after surgery (p<0.0001), but increased 6 months later (p=0.0016). BRAS symptoms increased just after surgery (p=0.0329) and until 6 months (p<0.0001) before decreasing (p<0.0001). Whatever the follow up, GHS and BRAS were better in the SNLB group than in the SNLB+ classical axillary dissection group. Mean differences were respectively 4.94 (p = 0.0185) and 6.28 (p = 0.0013). Conclusions: SNLB seems to improve QoL in breast cancer patients. However, surgeons must be cautious, SNLB with complementary axillary lymph node dissection results in a poorer QoL. No significant financial relationships to disclose.