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Long-term survival after sentinel lymph node biopsy or axillary lymph node dissection in pN0 breast cancer patients: a population-based study

  • Epidemiology
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Abstract

Purpose

Findings from randomized clinical trials have shown that survival in patients with sentinel lymph node (SLN)-negative breast cancer is noninferior with SLN biopsy (SLNB) alone versus further axillary lymph node dissection (ALND). However, the long-term outcome of these two surgical approaches in pN0 breast cancer patients in real-world setting remains uncertain.

Methods

We included patients diagnosed with pathologically staged T1-2N0M0 breast cancer between 2000 and 2015 in surveillance, epidemiology, and end results 18-registry database. Patients were considered to have undergone SLNB alone if they had ≤ 5 examined lymph nodes (ELNs), and ALND if they had ≥ 10 ELNs. The outcomes included overall survival (OS) and breast cancer-specific survival. Propensity score analyses by weighting and matching and multivariable Cox regression analysis were performed to minimize treatment selection bias.

Results

We included 309,430 patients (253,501 SLNB and 55,929 ALND). In the weighted cohort, ALND was associated with significantly lower OS (hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.10–1.16) and BCSS (HR 1.16; 95% CI 1.10–1.22) compared with SLNB alone. Both the propensity score-matching model and multivariable Cox model demonstrated a survival benefit for SLNB when compared with ALND. Subgroup analyses for key variables did not change these findings.

Conclusion

We found statistically significant differences in OS and BCSS between SLNB and ALND, though the magnitude of these differences was small. Our findings further support that SLNB alone should be the standard of care for patients who do not have metastatic lymph nodes identified during breast cancer surgery.

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Funding

This work was supported by a grant from Project funded by China Postdoctoral Science Foundation (2021M693654), National Natural Science Foundation of China (U1601224), and Natural Science Foundation of Guangdong Province (2019A1515011945).

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Author notes

  1. Qiufan Zheng, Hanjia Luo, and Wen Xia contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China

    Qiufan Zheng, Hanjia Luo, Wen Xia, Qianyi Lu, Kuikui Jiang, Ruoxi Hong, Fei Xu & Shusen Wang

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  1. Qiufan Zheng
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Contributions

Conception and design: QZ and SW. Financial support: QZ and SW. Administrative support: SW. Provision of study materials or patients: QZ, HL, and WX. Collection and assembly of data: QZ, HL, WX, and SW. Data analysis and interpretation: QZ, HL, WX, and SW. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to Shusen Wang.

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The study subjects were de-identified and there was no patient contact; thus, the study is exempt from an Institutional Review Board’s review.

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Zheng, Q., Luo, H., Xia, W. et al. Long-term survival after sentinel lymph node biopsy or axillary lymph node dissection in pN0 breast cancer patients: a population-based study. Breast Cancer Res Treat 196, 613–622 (2022). https://doi.org/10.1007/s10549-022-06746-6

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