A randomized controlled research on treating early breast cancer with axillary lymph node group dissec-tion oriented by sentinel lymph nodes instead of axillary dissection

Abstract

Objective To research the impact of axillary limph node group dissection oriented by sentinel lymph nodes instead of axillary dissection on upper limb lymph edema and disease-free survival(DFS). Methods We designed a randomized controlled research, which included 205 cases of operatable breast cancer(AJCC 7th: stage I or stage IIa)from Jan. 2011 to Jan. 2013. Those cases were separated into 2 groups randomly(random number method): group A underwent mastectomy(or lumpectomy)and axillary group lymphadenectomy oriented by sentinel lymph node biopsy(SLNB)(if positive continued for ALND)while group B underwent mastectomy(or lumpectomy)and axillary lymph node dissection(ALND). All patients underwent SLNB by blue dye method and received adjuvant therapy after surgery according to National Comprehensive Cancer Network(NCCN)guideline and Chinese anti-cancer association guideline. Results There were 101 cases in group A and 104 cases in group B, but 1 case in group A was excluded for false negative of SLN. The midium follow-up was 30 months. There were no significant differences of average age, tumor size, grade, estrogen receptor (ER), progesterone receptor(PR)and human epidermal growth factor receptor 2 (HER2)expression between the 2 groups. Group A had a lower frequency of lymph edema than group B(4.0% vs 17.3%, χ2=9.384, P=0.002), and also a milder degree(mild 2% vs 11.5%, middle 2% vs 3.8%, severe 0% vs 1.9%). There were no significant differences of upper limb sensory disorder(14.0% vs 16.3%, χ2=0.218, P=0.641), neither of DFS(Log-Rank analysis: 3-year average DFS 32.89 months vs 33.72 months, χ2=0.186, P=0.667; Cox risk model analysis: HR=1.395, P=0.495)between the 2 groups. Conclusion Axillary group lymphadenectomy oriented by SLNB can reduce the happening of lymph edema from ALND and has a comparative effect on DFS as ALND. Key words: Breast cancer; Sentinel lymph node; Lymph edema of upper limb