Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer

TY - JOUR

T1 - Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer

AU - Axelsson, C K

AU - Düring, M

AU - Christiansen, P M

AU - Wamberg, P A

AU - Søe, K L

AU - Møller, S

AU - Danish Breast Cancer Cooperative Group Surgical Study Group

N1 - Keywords: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Axilla; Breast Neoplasms; Chemotherapy, Adjuvant; Female; Humans; Kaplan-Meiers Estimate; Lymph Node Excision; Lymphatic Metastasis; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Postoperative Care; Prospective Studies; Treatment Outcome

PY - 2009

Y1 - 2009

N2 - BACKGROUND: This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies. METHODS: The follow-up analyses were based on 8657 patients with node-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years. RESULTS: The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant metastases (from 15.0 to 10.3 per cent; P < 0.001) and death as first event (from 7.5 to 5.5 per cent; P = 0.012). CONCLUSION: When ALND is indicated, at least ten axillary lymph nodes should be retrieved. The role of ALND as primary treatment has decreased significantly during the past decade. The findings leave the concept of the sentinel node biopsy intact, as a highly specific procedure compared to ALND.

AB - BACKGROUND: This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies. METHODS: The follow-up analyses were based on 8657 patients with node-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years. RESULTS: The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant metastases (from 15.0 to 10.3 per cent; P < 0.001) and death as first event (from 7.5 to 5.5 per cent; P = 0.012). CONCLUSION: When ALND is indicated, at least ten axillary lymph nodes should be retrieved. The role of ALND as primary treatment has decreased significantly during the past decade. The findings leave the concept of the sentinel node biopsy intact, as a highly specific procedure compared to ALND.

U2 - 10.1002/bjs.6350

DO - 10.1002/bjs.6350

M3 - Journal article

C2 - 19108002

SN - 0007-1323

VL - 96

SP - 40

EP - 46

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 1

ER -