Relationship of Sentinel and Axillary Lymph Node Status with Locoregional Recurrence/Metastasis: A Seven-Year Clinical Follow-Up Study
Jeffrey Petersen, Maria E Vergara-Lluri, Yasaman Omidvar, Raquel Prati, Sophia K Apple. David Geffen School of Medicine at UCLA, Los Angeles, CA
Background: Lymph node status is known to be the most important prognostic factor in breast cancer. More recently, the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial study suggested that axillary lymph node dissection (ALND) is not necessary in T1 and T2 breast carcinoma regardless of sentinel lymph node (SLN) status. The Z0011 trial advocated conservative management as disease-free survival and recurrence rates did not appear to differ between SLN alone versus SLN with ALND. We sought to examine SLN and ALND positive rates and to evaluate the probability of locoregional recurrence and/or metastasis (LRM) with regard to SLN and ALN status.
Design: A retrospective analysis of all breast cancer patients at our medical center from 2003-2007 who underwent both SLN and ALND was performed (n=112), regardless of pathologic tumor stage. The median clinical follow-up was 7.33 years. Patients lost to follow-up were excluded from study. We then compared multiple clinicopathological parameters of patients who had LRM against those that were disease free (DF) using Fischer's exact test on GraphPad Prism statistical analysis software.
Results: SLN was positive in 70% of the total (78/112); including 8 (7%) with isolated tumor cells (ITC); 11 (10%) with micrometastases; and 59 (53%) with macrometastases. ALND was positive in 35% of the total (39/112); including 0% with ITC; 3 (3%) with micrometastases, and 36 (32%) with macrometastases. Thirty-six of 78 patients with positive SLN had positive ALND (46%), while 31 of 34 patients with negative SLN had negative ALND (91%). The risk that a patient with positive SLN having a positive ALN was approximately nine times higher than the risk of a patient with negative SLN having a positive ALN, with an odds ratio of 8.88 (p<0.0001, 95% CI 2.497 to 31.42). With LRM as a clinical endpoint, all clinical parameters including age, menopausal status, tumor grade, tumor stage, tumor biomarkers, lymphovascular invasion, types of surgery, radiation, chemotherapy, and neoadjuvant therapy did not predict LRM.
Conclusions: While positive SLN predicts positive ALND, nodal status did not predict locoregional recurrence/metastases. Our study appears to support conservative management of breast cancer patients with positive sentinel lymph nodes.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 29, Tuesday Morning