Accueil >
Publications >
The need to tailor the omission of axillary lymph node dissection to patients with good prognosis and sentinel node micro‐metastases

The need to tailor the omission of axillary lymph node dissection to patients with good prognosis and sentinel node micro‐metastases

1 févr. 2023Cancer Medicine

Auteurs

Gilles Houvenaeghel, Alexandre de Nonneville, Nicolas Chopin, Jean‐Marc Classe, Chafika Mazouni, Marie‐Pierre Chauvet, Fabien Reyal, Christine Tunon de Lara, Eva Jouve, Roman Rouzier, Emile Daraï, Pierre Gimbergues, Charles Coutant, Anne Sophie Azuar, Richard Villet, Patrice Crochet, Sandrine Rua, Marie Bannier, Monique Cohen, Jean‐Marie Boher

Résumé

Abstract

Background

Results of IBCSG‐23‐01‐trial which included breast cancer patients with involved sentinel nodes (SN) by isolated‐tumor‐cells or micro‐metastases supported the non‐inferiority of completion axillary‐lymph‐node‐dissection (cALND) omission. However, current data are considered insufficient to avoid cALND for all patients with SN‐micro‐metastases.

Methods

To investigate the impact of cALND omission on disease‐free‐survival (DFS) and overall survival (OS), we analyzed a cohort of 1421 patients <75 years old with SN‐micro‐metastases who underwent breast conservative surgery (BCS). We used inverse probability of treatment weighting (IPTW) to obtain adjusted Kaplan–Meier estimators representing the experience in the analysis cohort, based on whether all or none had been subject to cALND omission.

Results

Weighted log‐rank tests comparing adjusted Kaplan–Meier survival curves showed significant differences in OS (p‐value = 0.002) and borderline significant differences in DFS (p‐value = 0.090) between cALND omission versus cALND. Cox's regression using stabilized IPTW evidenced an average increase in the risk of death associated with cALND omission (HR = 2.77, CI95% = 1.36–5.66). Subgroup analyses suggest that the rates of recurrence and death associated with cALND omission increase substantially after a large period of time in the half sample of women less likely to miss cALND.

Conclusions

Using IPTW to estimate the causal treatment effect of cALND in a large retrospective cohort, we concluded cALND omission is associated with an increased risk of recurrence and death in women of <75 years old treated by BCS in the absence of a large consensus in favor of omitting cALND. These results are particularly contributive for patients treated by BCS where cALND omission rates increase over time.