Comparable Survival Between pN0 Breast Cancer Patients Undergoing Sentinel Node Biopsy and Extensive Axillary Dissection: A Report From the Korean Breast Cancer Society

Purpose Recent studies showing survival benefit of extensive axillary lymph node dissection (ALND) in pN0 breast cancer have challenged the concept of sentinel node biopsy (SNB). In this study, the survival and recurrence after SNB alone and ALND in pN0 Korean breast cancer patients were investigated. Patients and Methods Using information from two large databases, including a Korean nationwide registry, we assessed survival relative to the extent of ALND in pN0 breast cancer patients. We also compared the survival of pN0 patients who underwent SNB alone with survival in those who underwent varying degrees of ALND. Results In an analysis of 1,607 pN0 patients from a single institution, less extensive ALND significantly increased the risks of breast cancer death and systemic recurrence but not of locoregional recurrence. These findings were validated by an analysis of nationwide registry data on 17,672 pN0 patients; patients with > 20 dissected lymph nodes had significantly better overall survival (OS) and breast cancer-specific survival (BCSS) than those with 10 to 20 or 20 dissected lymph nodes), despite the small number of lymph nodes removed. Conclusion Extensive ALND is associated with better survival and less systemic recurrence than less extensive ALND in patients with pN0 breast cancer. However, SNB alone showed excellent survival results, similar to those of extensive ALND, supporting the long-term oncologic safety of SNB. J Clin Oncol 28: 1692-1699. (C) 2010 by American Society of Clinical OncologyCanavese G, 2009, ANN ONCOL, V20, P1001, DOI 10.1093/annonc/mdn746Veronesi U, 2009, EUR J CANCER, V45, P1381, DOI 10.1016/j.ejca.2008.11.041Sanghani M, 2009, CANCER, V115, P1613, DOI 10.1002/cncr.24174Maaskant AJG, 2009, BREAST CANCER RES TR, V113, P173, DOI 10.1007/s10549-008-9913-8Axelsson CK, 2009, BRIT J SURG, V96, P40, DOI 10.1002/bjs.6350Zavagno G, 2008, ANN SURG, V247, P207, DOI 10.1097/SLA.0b013e31812e6a73Cufer T, 2008, ANN ONCOL, V19, P41, DOI 10.1093/annonc/mdn439Krag DN, 2007, LANCET ONCOL, V8, P881, DOI 10.1016/S1470-2045(07)70278-4Ahn SH, 2007, J CLIN ONCOL, V25, P2360, DOI 10.1200/JCO.2006.10.3754Benson JR, 2007, LANCET ONCOL, V8, P331Gupta GP, 2006, CELL, V127, P679, DOI 10.1016/j.cell.2006.11.001Vanderveen KA, 2006, ANN SURG ONCOL, V13, P1450, DOI 10.1245/s10434-006-9109-6Mansel RE, 2006, J NATL CANCER I, V98, P599, DOI 10.1093/jnci/djj158Pater J, 2006, J NATL CANCER I, V98, P568, DOI 10.1093/jnci/djj183Smigal C, 2006, CA-CANCER J CLIN, V56, P168Rudenstam CM, 2006, J CLIN ONCOL, V24, P337, DOI 10.1200/JCO.2005.01.5784Henderson IC, 2006, J CLIN ONCOL, V24, P325, DOI 10.1200/JCO.2005.03.6178JEONG J, 2006, J BREAST CANCER, V9, P151Lyman GH, 2005, J CLIN ONCOL, V23, P7703, DOI 10.1200/JCO.2005.08.001Purushotham AD, 2005, J CLIN ONCOL, V23, P4312, DOI 10.1200/JCO.2005.03.228Martelli G, 2005, ANN SURG, V242, P1, DOI 10.1097/01.sla.0000167759.15670.14SHIN HR, 2005, CANC RES TREAT, V37, P325Somner JEA, 2004, J CLIN PATHOL, V57, P845, DOI 10.1136/jcp.2003.015560Louis-Sylvestre C, 2004, J CLIN ONCOL, V22, P97, DOI 10.1200/JCO.2004.12.108Krag DN, 2003, ANN SURG ONCOL, V10, P1152, DOI 10.1245/ASO.2003.03.073Cody HS, 2003, ANN SURG ONCOL, V10, P1131, DOI 10.1245/ASO.2003.10.905Edge SB, 2003, J NATL CANCER I, V95, P1514, DOI 10.1093/jnci/djg076Veronesi U, 2003, NEW ENGL J MED, V349, P546Polednak AP, 2003, ANN SURG, V237, P163Fisher B, 2002, NEW ENGL J MED, V347, P567Weir L, 2002, J CLIN ONCOL, V20, P1793, DOI 10.1200/JCO.2002.07.112Krag D, 2001, AM J SURG, V182, P411Tjan-Heijnen VCG, 2001, BREAST CANCER RES TR, V70, P81Iyer RV, 2000, INT J RADIAT ONCOL, V47, P1177Greco M, 2000, ANN SURG, V232, P1Cady B, 2000, ANN SURG, V232, P8Bland KI, 1999, J AM COLL SURGEONS, V188, P586Orr RK, 1999, ANN SURG ONCOL, V6, P109GIULIANO AE, 1995, ANN SURG, V222, P394GIULIANO AE, 1994, ANN SURG, V220, P391KRAG DN, 1993, SURG ONCOL, V2, P335FEINSTEIN AR, 1985, NEW ENGL J MED, V312, P1604HARRIS JR, 1985, BREAST CANCER RES TR, V5, P17