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Axillary lymph node dissection failed to improve outcomes in T1N0 breast cancer
Patients with T1N0 breast cancer who underwent immediate axillary lymph node dissection experienced similar DFS and OS than patients who did not undergo the procedure, according to results of a single-center study.
Although axillary surgery is a fundamental treatment component in early breast cancer, researchers sought to evaluate its effect on 517 women aged 30 to 65 years with T1N0 disease.
Researchers assigned 272 women quadrantectomy with axillary lymph node dissection, and the other 245 women were assigned quadrantectomy without axillary lymph node dissection.
All patients underwent radiation therapy to the residual breast.
Patients who did not undergo axillary lymph node dissection underwent chemotherapy based on ER status, tumor grade, and human epidermal growth factor receptor 2 and laminin receptor status. Chemotherapy for patients who underwent axillary lymph node dissection was based on lymph node status, ER status and tumor grade.
OS served as the primary endpoint. DFS was a secondary endpoint in both arms. Rate and time of axillary lymph node recurrence was a secondary endpoint in the arm that did not undergo dissection.
Median follow-up was more than 10 years.
When comparing the dissection and non-dissection arms, researchers calculated an estimated adjusted HR of 1.09 (95% CI, 0.59-2) for OS and an HR of 1.04 (95% CI, 0.56-1.94) for DFS.
Twenty-two patients (9%) who did not undergo dissection experienced axillary lymph node recurrence. The median time from breast surgery to recurrence was 30 months (interquartile range, 24.2-73.4 months).
“Although we expect that axillary surgery will retain its role in local disease control in patients with clinically evident lymph node involvement, the results of the current study provide striking evidence that a few fundamental, well-known and easily detectable biological characteristics of the primary tumor are sufficient for guiding adjuvant treatment,” the researchers wrote. “The increasing number of molecular signatures that can define biomarkers predictive of tumor aggressiveness promise a more precise evaluation of patients in whom systemic therapy can be avoided.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Local therapies for cancer are important when systemic therapies are suboptimal or poorly effective. With improved systemic therapies and increasing recognition as to how to optimally use systemic therapies due to biomarker-driven treatment assignments, the need for extensive surgeries becomes less important — for instance, surgery is no longer “required” when patients are diagnosed with Hodgkin’s lymphoma due to the development of better chemotherapy regimens. The report by Agresti and colleagues suggests that the optimal modern use of systemic breast cancer therapy has begun to reduce the importance of surgical axillary node dissection to prevent local recurrence of disease. With increased understanding of the biology of breast cancer, I expect that we will continue to see the role and types of surgery changing in the treatment of breast cancer in the future.