Skip to main content

Advertisement

SpringerLink
Log in

Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes: a nationwide study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

We estimated the impact of axillary lymph node dissection (ALND) on the risk of axillary recurrence (AR) and overall survival (OS) in breast cancer patients with micrometastases or isolated tumor cells (ITC) in sentinel nodes. We used the Danish Breast Cancer Cooperative Group (DBCG) database to identify patients with micrometastases or ITC in sentinel nodes following surgery for primary breast cancer between 2002 and 2008. A Cox proportional hazard regression model was developed to assess the hazard ratios (HR) for AR and OS between patients with and without ALND. We identified 2074 patients, of which 240 did not undergo further axillary surgery. The 5-year cumulated incidence for AR was 1.58 %. No significant difference in AR was seen between patients with and without ALND. The age adjusted HR for AR if ALND was omitted was 1.79 (95 % CI 0.41–7.80, P = 0.44) in patients with micrometastases and 2.21 (95 % CI 0.54–8.95, P = 0.27), in patients with ITC after a median follow-up of 6 years and 3 months. There was no significant difference in overall survival between patients with and without ALND, when adjusting for age, co-morbidity, tumor size, histology type, malignancy grade, lymphovascular invasion, hormone receptor status, adjuvant systemic treatment and radiotherapy, with a HR for death if ALND was omitted of 1.21 (95 % CI 0.86–1.69, P = 0.27) in patients with micrometastases and 0.96 (95 % CI 0.57–1.62, P = 0.89) in patients with ITC after a medium follow-up on 8 and 5 years. In this nationwide study, we found a low risk of AR on 1.58 % and we did not find a significantly increased risk of AR if ALND was omitted in patients with micrometastases or ITC in sentinel nodes. Furthermore, no significant difference in overall survival was seen between patients with and without ALND when adjusting for adjuvant treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, Saha S, Hunt KK, Morrow M, Ballman K (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

    PubMed  Google Scholar 

  2. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, McCall LM, Morrow M (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

    Article  CAS  PubMed  Google Scholar 

  3. Cserni G, Gregori D, Merletti F, Sapino A, Mano MP, Ponti A, Sandrucci S, Baltas B, Bussolati G (2004) Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 91:1245–1252

    Article  CAS  PubMed  Google Scholar 

  4. van Deurzen CH, de Boer M, Monninkhof EM, Bult P, van der Wall e, Tjan-Heijnen VC, van Diest PJ (2008) Non-sentinel lymph node metastases associated with isolated breast cancer cells in the sentinel node. J Natl Cancer Inst 100:1574–1580

    Article  PubMed Central  PubMed  Google Scholar 

  5. Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, Port E, Sacchini V, Sclafani L, VanZee K, Wagman R, Borgen PI, Cody HS III (2004) The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg 240:462–468

    Article  PubMed Central  PubMed  Google Scholar 

  6. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, Ashikaga T, Weaver DL, Mamounas EP, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Wolmark N (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11:927–933

    Article  PubMed Central  PubMed  Google Scholar 

  7. Salhab M, Patani N, Mokbel K (2011) Sentinel lymph node micrometastasis in human breast cancer: an update. Surg Oncol 20:e195–e206. doi:10.1016/j.suronc.2011.06.006

    Article  PubMed  Google Scholar 

  8. Pepels MJ, Vestjens JH, de Boer M, Smidt M, van Diest PJ, Borm GF, Tjan-Heijnen VC (2011) Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review. Breast Cancer Res Treat 125:301–313

    Article  PubMed  Google Scholar 

  9. Erb KM, Shapiro-Wright HM, Julian TB (2010) Axillary recurrences following positive sentinel lymph node biopsy with individual tumor cells or micrometastases and no axillary dissection. Breast Dis 31:83–90

    PubMed Central  PubMed  Google Scholar 

  10. Francissen CM, Dings PJ, van Dalen T, Strobbe LJ, van Laarhoven HW, de Wilt JH (2012) Axillary recurrence after a tumor-positive sentinel lymph node biopsy without axillary treatment: a review of the literature. Ann Surg Oncol 19:4140–4149

    Article  PubMed Central  PubMed  Google Scholar 

  11. Cox CE, Kiluk JV, Riker AI, Cox JM, Allred N, Ramos DC, Dupont EL, Vrcel V, Diaz N, Boulware D (2008) Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg 206:261–268

    Article  PubMed  Google Scholar 

  12. Pepels MJ, de Boer M, Bult P, van Dijck JA, van Deurzen CH, Menke-Pluymers MB, van Diest PJ, Borm GF, Tjan-Heijnen VC (2012) Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells. Ann Surg 255:116–121

    Article  PubMed  Google Scholar 

  13. Degnim AC, Zakaria S, Boughey JC, Sookhan N, Reynolds C, Donohue JH, Farley DR, Grant CS, Hoskin T (2010) Axillary recurrence in breast cancer patients with isolated tumor cells in the sentinel lymph node [AJCC N0(i+)]. Ann Surg Oncol 17:2685–2689. doi:10.1245/s10434-010-1062-8

    Article  PubMed  Google Scholar 

  14. Onishi T, Jinno H, Takahashi M, Hayashida T, Sakata M, Nakahara T, Shigematsu N, Mukai M, Kitagawa Y (2010) Non-sentinel lymph node status and prognosis of breast cancer patients with micrometastatic sentinel lymph nodes. Eur Surg Res 45:344–349

    Article  CAS  PubMed  Google Scholar 

  15. Pernas S, Gil M, Benitez A, Bajen MT, Climent F, Pla MJ, Benito E, Guma A, Gutierrez C, Pisa A, Urruticoechea A, Perez J, Gil GM (2010) Avoiding axillary treatment in sentinel lymph node micrometastases of breast cancer: a prospective analysis of axillary or distant recurrence. Ann Surg Oncol 17:772–777

    Article  PubMed  Google Scholar 

  16. Fan YG, Tan YY, Wu CT, Treseler P, Lu Y, Chan CW, Hwang S, Ewing C, Esserman L, Morita E, Leong SP (2005) The effect of sentinel node tumor burden on non-sentinel node status and recurrence rates in breast cancer. Ann Surg Oncol 12:705–711

    Article  PubMed  Google Scholar 

  17. Rayhanabad J, Yegiyants S, Putchakayala K, Haig P, Romero L, DiFronzo LA (2010) Axillary recurrence is low in patients with breast cancer who do not undergo completion axillary lymph node dissection for micrometastases in sentinel lymph nodes. Am Surg 76:1088–1091

    PubMed  Google Scholar 

  18. Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, Gentilini O, Mastropasqua MG, Mazzarol G, Massarut S, Garbay JR, Zgajnar J, Galatius H, Recalcati A, Littlejohn D, Bamert M, Colleoni M, Price KN, Regan MM, Goldhirsch A, Coates AS, Gelber RD, Veronesi U (2013) Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol 14:297–305

    Article  PubMed Central  PubMed  Google Scholar 

  19. Moller S, Jensen MB, Ejlertsen B, Bjerre KD, Larsen M, Hansen HB, Christiansen P, Mouridsen HT (2008) The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise. Acta Oncol 47:506–524

    Article  PubMed  Google Scholar 

  20. Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark G, Edge SB, Hayes DF, Hughes LL, Hutter RV, Morrow M, Page DL, Recht A, Theriault RL, Thor A, Weaver DL, Wieand HS, Greene FL (2002) Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20:3628–3636

    Article  PubMed  Google Scholar 

  21. Christiansen P, Friis E, Balslev E, Jensen D, Moller S (2008) Sentinel node biopsy in breast cancer: five years experience from Denmark. Acta Oncol 47:561–568

    Article  PubMed  Google Scholar 

  22. Yi M, Giordano SH, Meric-Bernstam F, Mittendorf EA, Kuerer HM, Hwang RF, Bedrosian I, Rourke L, Hunt KK (2010) Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. Ann Surg Oncol 17:343–351

    Article  PubMed Central  PubMed  Google Scholar 

  23. Bilimoria KY, Bentrem DJ, Hansen NM, Bethke KP, Rademaker AW, Ko CY, Winchester DP, Winchester DJ (2009) Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol 27:2946–2953

    Article  PubMed  Google Scholar 

  24. Kapoor NS, Sim MS, Lin J, Giuliano AE (2012) Long-term outcome of patients managed with sentinel lymph node biopsy alone for node-negative invasive breast cancer. Arch Surg 16:1–7

    Google Scholar 

  25. Galimberti V, Botteri E, Chifu C, Gentilini O, Luini A, Intra M, Baratella P, Sargenti M, Zurrida S, Veronesi P, Rotmensz N, Viale G, Sonzogni A, Colleoni M, Veronesi U (2012) Can we avoid axillary dissection in the micrometastatic sentinel node in breast cancer? Breast Cancer Res Treat 131:819–825. doi:10.1007/s10549-011-1486-2

    Article  PubMed  Google Scholar 

  26. Tvedskov TF, Jensen MB, Balslev E, Ejlertsen B, Kroman N (2011) Stage migration after introduction of sentinel lymph node dissection in breast cancer treatment in Denmark: a nationwide study. Eur J Cancer 47:872–878

    Article  PubMed  Google Scholar 

  27. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, Cataliotti L, Westenberg AH, Klinkenbijl JH, Orzalesi L, Bouma WH, van der Mijle HC, Nieuwenhuijzen GA, Veltkamp SC, Slaets L, Duez NJ, de Graaf PW, van Dalen T, Marinelli A, Rijna H, Snoj M, Bundred NJ, Merkus JW, Belkacemi Y, Petignat P, Schinagl DA, Coens C, Messina CG, Bogaerts J, Rutgers EJ (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310. doi:10.1016/S1470-2045(14)70460-7

    Article  PubMed Central  PubMed  Google Scholar 

  28. Sola M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, Moral A, Ballester B, Vidal S (2013) Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol 20:120–127. doi:10.1245/s10434-012-2569-y

    Article  PubMed  Google Scholar 

  29. de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, Nortier JW, Rutgers EJ, Seynaeve C, Menke-Pluymers MB, Bult P, Tjan-Heijnen VC (2009) Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med 361:653–663

    Article  PubMed  Google Scholar 

  30. Kihara SM, Giblett NA, McNeil C, Crea P (2010) Sentinel node micrometastases in breast cancer: clinical outcome. Asia Pac J Clin Oncol 6:330–341

    Article  PubMed  Google Scholar 

  31. Gnant M, Harbeck N, Thomssen C (2011) St. Gallen 2011: summary of the consensus discussion. Breast Care (Basel) 6:136–141

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Copenhagen University Hospital, Afs 4124, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark

    Tove Filtenborg Tvedskov & Niels Kroman

  2. Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark

    Maj-Britt Jensen

  3. Department of Clinical Oncology and Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark

    Bent Ejlertsen

  4. Breast Surgery Unit, Department of Surgery, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark

    Peer Christiansen

  5. Department of Pathology, Herlev Hospital, Copenhagen, Denmark

    Eva Balslev

Authors
  1. Tove Filtenborg Tvedskov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maj-Britt Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bent Ejlertsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peer Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Balslev
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Niels Kroman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tove Filtenborg Tvedskov.

Ethics declarations

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the Danish Data Protection Agency (J.nr. 2009-41-3703).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tvedskov, T.F., Jensen, MB., Ejlertsen, B. et al. Prognostic significance of axillary dissection in breast cancer patients with micrometastases or isolated tumor cells in sentinel nodes: a nationwide study. Breast Cancer Res Treat 153, 599–606 (2015). https://doi.org/10.1007/s10549-015-3560-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3560-7

Keywords

Search

Navigation