Axillary dissection versus axillary observation for low risk, clinically node-negative invasive breast cancer : a systematic review and meta-analysis

Sangha, MS; Baker, RD; Ahmed, M

Abstract

1. To systematically analyse studies comparing survival outcomes between axillary lymph-node dissection (ALND) and axilla observation (Obs), in women with low-risk, clinically node-negative breast cancer. 2. To consider results in the context of current axillary surgery de-escalation trials and studies. 9 eligible studies were identified, 6 RCTs and 3 non-randomized studies (4236 women in total). Outcomes assessed: overall survival (OS) and disease-free survival (DFS). The logged (ln) hazard ratio (HR) was calculated and used as the statistic of interest. Data was grouped by follow-up. Meta-analyses found no significant difference in OS at 5, 10 and 25-years follow-up (5-year ln HR = 0.08, 95% CI - 0.09, 0.25, 10-year ln HR =  0.33, 95% CI - 0.07, 0.72, 25-year ln HR = 0.00, 95% CI - 0.18, 0.19). ALND caused improvement in DFS at 5-years follow-up (ln HR = 0.16, 95% CI 0.03, 0.29), this was not demonstrated at 10 and 25-years follow-up (10-year ln HR = 0.07, 95% CI - 0.09, 0.23, 25-year ln HR = - 0.03, 95% CI - 0.21, 0.16). Studies supporting ALND for DFS at 5-years follow-up had greater relative chemotherapy use in the ALND cohort. ALND does not cause a significant improvement in OS in women with clinically node-negative breast cancer. ALND may improve DFS in the short term by tailoring a proportion of patients towards chemotherapy. Our evidence suggests that when the administration of systemic therapy is balanced between the two arms, axillary de-escalation studies will likely find no difference in OS or DFS. [Abstract copyright: © 2021. The Author(s).]

Citation

Sangha, M., Baker, R., & Ahmed, M. (2021). Axillary dissection versus axillary observation for low risk, clinically node-negative invasive breast cancer : a systematic review and meta-analysis. Breast Cancer, 28(6), 1212-1224. https://doi.org/10.1007/s12282-021-01273-6

• Journal Article Type: Article
• Acceptance Date: Jul 5, 2021
• Online Publication Date: Jul 9, 2021
• Publication Date: Nov 1, 2021
• Deposit Date: Jul 23, 2021
• Publicly Available Date: Jul 23, 2021
• Journal: Breast Cancer
• Print ISSN: 1340-6868
• Electronic ISSN: 1880-4233
• Publisher: Springer Verlag
• Volume: 28
• Issue: 6
• Pages: 1212-1224
• DOI: https://doi.org/10.1007/s12282-021-01273-6
• Publisher URL: https://doi.org/10.1007/s12282-021-01273-6
• Related Public URLs: http://link.springer.com/journal/12282
• Additional Information: Additional Information : ** From PubMed via Jisc Publications Router **Journal IDs: eissn 1880-4233 **Article IDs: pubmed: 34241800; pii: 10.1007/s12282-021-01273-6 **History: accepted 05-07-2021; submitted 17-04-2021