Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Manon J. Pepels , Johanna H. M. J. Vestjens , Maaike de Boer , Marjolein Smidt , Paul J. van Diest , George F. Borm , Vivianne C. G. Tjan-Heijnen
- چاپ و سال / کشور: 2010
Description
Physicians are moving away from routine axillary lymph node dissection (ALND) in clinically nodenegative breast cancer. We conducted a systemic review on the safety of this policy. Pubmed and Cochrane library were searched for. Sixty-eight studies were included: studies of clinically node-negative patients in the pre-sentinel node (SN) era; observational studies of SN-negative patients, without ALND; comparative studies of SN-negative patients, with a non-ALND and an ALND group; SN-positive studies, of patients without ALND. Primary endpoint was the pooled axillary recurrence rate (ARR) of each category; secondary endpoint was overall survival (OS) rate. In pre-SN studies, with larger tumors and less systemic therapy, ARR without ALND after 5–10 years follow-up was 12–18%, with 5% reduced OS. In the observational SN-negative studies, with median follow-up of 36 months, the pooled ARR was 0.6% (95% CI 0.6–0.8). In the comparative SN-negative studies, pooled ARR was 0.4% (95% CI 0.2–0.6) without ALND versus 0.3% (95% CI 0.1–0.6) with ALND at 31 and 47 months, respectively, and no survival disadvantage. In SN-positive studies, ARR was up to 1.7% (95% CI 1.0–2.7) at 30 months. For patients with an H&E positive SN the ARR without ALND was 5% after 23 months, which may imply rates as high as 13 and 18% after 5 and 8 years. In conclusion, this systematic review confirms the safety of omitting ALND in SN-negative patients. There is a potential role for avoiding ALND in selected SN-positive patients, but eligibility criteria and the role of systemic therapy need further to be elucidated.
Breast Cancer Res Treat (2011) 125:301–313 Received: 5 August 2010 / Accepted: 30 September 2010 / Published online: 24 October 2010 Springer Science+Business Media, LLC. 2010
