医学
腋窝淋巴结清扫术
乳腺癌
前哨淋巴结
乳房切除术
放射治疗
腋窝
外科
哨兵节点
腋窝淋巴结
淋巴结
临床终点
癌症
随机对照试验
内科学
作者
Sabine R de Wild,Lori M. van Roozendaal,Johannes H.W. de Wilt,Thijs van Dalen,Jos A. van der Hage,Frederieke van Duijnhoven,Janine M. Simons,Robert-Jan Schipper,Linda de Munck,Sander M. J. van Kuijk,Liesbeth Boersma,Sabine C. Linn,Marc Lobbes,Philip Poortmans,Vivianne C. G. Tjan‐Heijnen,K. K. B. T. Van de Vijver,Jolanda De Vries,A.H. Westenberg,Luc J. A. Strobbe,Marjolein L. Smidt
摘要
Trials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1-2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis.Women diagnosed in 2013-2014 with unilateral cT1-2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi-pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others.In total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths.In this registry study of patients with cT1-2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment.
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