Sentinel lymph node biopsy is associated with improved survival compared to level I & II axillary lymph node dissection in node negative breast cancer patients

• Published in: European journal of surgical oncology 2009-08, Vol.35 (8), p.805-813
• Main Authors: Langer, I, Guller, U, Hsu-Schmitz, S.F, Ladewig, A, Viehl, C.T, Moch, H, Wight, E, Harder, F, Oertli, D, Zuber, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Axilla; Axillary dissection; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Disease-free and overall survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Long-term follow-up; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Sentinel lymph node; Sentinel Lymph Node Biopsy; Surgery; Survival Analysis
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2008.09.006

Abstract Objective The few long-term follow-up data for sentinel lymph node (SLN) negative breast cancer patients demonstrate a 5-year disease-free survival of 96–98%. It remains to be elucidated whether the more accurate SLN staging defines a more selective node negative patient group and whether this is associated with better overall and disease-free survival compared with level I & II axillary lymph node dissection (ALND). Methods Three-hundred and fifty-five consecutive node negative patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, pN0/pNSN 0) were assessed from our prospective database. Patients underwent either ALND ( n = 178) in 1990–1997 or SLN biopsy ( n = 177) in 1998–2004. All SLN were examined by step sectioning, stained with H&E and immunohistochemistry. Lymph nodes from ALND specimens were examined by standard H&E only. Neither immunohistochemistry nor step sections were performed in the analysis of ALND specimen. Results The median follow-up was 49 months in the SLN and 133 months in the ALND group. Patients in the SLN group had a significantly better disease-free ( p = 0.008) and overall survival ( p = 0.034). After adjusting for other prognostic factors in Cox proportional hazard regression analysis, SLN procedure was an independent predictor for improved disease-free (HR: 0.28, 95% CI: 0.10–0.73, p = 0.009) and overall survival (HR: 0.34, 95% CI: 0.14–0.84, p = 0.019). Conclusions This is the first prospective analysis providing evidence that early stage breast cancer patients with a negative SLN have an improved disease-free and overall survival compared with node negative ALND patients. This is most likely due to a more accurate axillary staging in the SLN group.