Abstract
BackgroundThe Z0011 trial results have shown that axillary lymph node dissection (ALND) can be avoided in cT1-2 patients undergoing breast conservation surgery with 1–2 metastatic sentinel lymph nodes (SLNs). We compared the clinicopathological characteristics of the Z0011 eligible non-screen detected breast cancer patients’ cohort with the Z0011 trial study population. Additionally, we have explored the effect of non-sentinel metastasis on adjuvant treatment decisions and survival.MethodsThe details of early breast cancer (EBC) patients fulfilling Z0011 eligibility criteria were retrieved from a prospectively maintained database (2013–2017) and electronic medical records. We used Statistical Package for the Social Sciences 25 and Stata V15 for the data analysis.Results128/194 (66%) sentinel lymph node biopsy positive patients had fulfilled the Z0011 inclusion criteria. Compared to the Z0011 study, our cohort patients were younger, with more aggressive disease (higher T2, Grade 3), had a higher rate of macrometastasis (82.8% versus 58.8%) and non-SLN metastasis (48% versus 27%). The information gained by ALND had changed decisions for chemotherapy in 3% and no change of radiotherapy in Z0011 eligible patients. Further nodal positivity in completion ALND was not significantly associated with overall survival (p = 0.86) and disease-free survival (p = 0.5).ConclusionZ0011 eligible Indian EBC patients are significantly different from the Z0011 study population, with younger age of presentation, higher grade, a higher rate of both SLN macro metastasis and non-SLN positivity. The impact of non-sentinel metastasis on adjuvant treatment decisions and survival is minimal.
Highlights
In the last three decades, surgical management of axilla has evolved from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) in the majority of breastPublished: 26/11/2021 Received: 04/07/2021Publication costs for this article were supported by ecancer (UK Charity number 1176307).Copyright: © the authors; licensee ecancermedicalscience
636 patients had SLNB during the study period, and sentinel lymph nodes (SLNs) were identified in 606 patients, with an identification rate of 95.2%. 194/606 (32%) patients had metastatic SLN. 128/194 (66%) patients fulfilled the inclusion criteria of the Z0011 study (Figure 1)
The patients were divided into two groups as per metastatic lymph nodes in completion ALND – 66 (51.6%) had no further positive nodes (Group 1), and 62 (48.4%) had additional metastatic nodes (Group 2)
Summary
In the last decade, three randomised controlled trials (Z0011, International Breast Cancer Study Group (IBCSG) – 01 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS)) have published their long-term results, with non-inferior survival outcomes following omission of ALND in a selected group of early breast cancer (EBC) patients with metastatic SLNs [5,6,7]. The Z0011 trial results have shown that axillary lymph node dissection (ALND) can be avoided in cT1-2 patients undergoing breast conservation surgery with 1–2 metastatic sentinel lymph nodes (SLNs). We have explored the effect of non-sentinel metastasis on adjuvant treatment decisions and survival
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