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Survival impact and predictive factors of axillary recurrence after sentinel biopsy. | LitMetric

AI Article Synopsis

  • - The study analyzed 14,095 breast cancer patients to determine the rate and factors affecting axillary recurrence (AR) after sentinel lymph node biopsy, finding an overall AR rate of just 0.51% during a median follow-up of 55.2 months.
  • - Key predictors for AR included higher tumor grades, lack of radiotherapy, and specific tumor subtypes, particularly noting higher AR rates in triple-negative and HER2-positive tumors.
  • - AR was significantly associated with lower overall survival rates, particularly in patients with early-onset AR, highlighting the need for systemic treatment in cases of isolated AR, though the actual benefits of such treatments are still unclear.

Article Abstract

Background: The rate of axillary recurrence (AR) after sentinel lymph node biopsy is usually low but few studies investigated its impact on survival. Our aim was to determine the rate and predictive factors of AR in a large cohort of breast cancer patients and its impact on survival.

Patients And Methods: From 1999 to 2013, 14,095 patients who underwent surgery for clinically N0 previously untreated breast cancer and had sentinel lymph node biopsy were analysed. A simplified score predictive of AR was established.

Results: Median follow-up was 55.2 months. AR was observed in 0.51% of cases, with a median time to onset of 43.4 months. In multivariate analysis, the occurrence of AR was significantly correlated with grade 2 or 3 disease, absence of radiotherapy and tumour subtype (hormonal receptor [HR]- / human estrogen receptor [HER]+). AR rates were 1% for triple-negative tumours, 2.8% for HER2-positive tumours, 0.4% for luminal A tumours, 0.9% for HER2-negative luminal B tumours, and 0.5% for HER2-positive luminal B tumours. A simplified score predictive of the occurrence of AR was established. Patients could be divided into three different score groups (p < 0.0001). In multivariate analysis, overall survival was significantly lower in cases of AR (p < 0.0001), age >50, lymphovascular invasion, grade 3 disease, sentinel node (SN) macrometastases, tumour size >20 mm, absence of chemotherapy and triple-negative phenotype. Survival in patients with AR was significantly lower in case of early-onset (2 years) AR (p = 0.017).

Conclusions: Isolated AR is more common in Her2-positive/HR-negative triple-negative tumours with a more severe prognosis in triple-negative and Her2-positive/HR-negative tumours, and represents an independent adverse factor justifying an indication for systemic treatment for AR treatment. However, the benefit of any systemic treatment remains to be proven.

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Source
http://dx.doi.org/10.1016/j.ejca.2016.01.019DOI Listing

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