Abstract 242P
Background
The management of axillary lymph nodes in breast cancer patients has changed over the past years. The ACOSOG-Z0011 clinical trial introduced drastic changes to the traditional surgical practice for early breast cancer with positive sentinel lymph nodes (SLNs). This study evaluates how these changes have affected the surgical management of early breast cancer at our institution.
Methods
A retrospective chart review was conducted for Lebanese women with a diagnosis of invasive breast cancer and who were ≥18 years of age, had undergone upfront breast-conserving surgery, and SLNB without any prior chemotherapy had no distant metastasis and had one or more positive SLNs, between the years 2011 and 2016.
Results
Data from our cohort shows that 78% of patients out of the 230 with clinically negative nodes go on to have negative nodes on surgical sentinel pathology as well. However, the incidence of micro-mets is 5.5% amongst positive SLNs versus 94% of positive SLNs having macro-mets. Our findings show that 40.9% of cases had 2 or fewer SLNs retrieved while 23.2% had more than 5 nodes retrieved (median 3, range 1-12). Patients receiving one or more types of adjuvant therapy amounted to 96.7%. Follow-up data showed event occurrence rates as depicted in the table. The rates of ALND were analyzed over 2 periods of time to evaluate the adoption of the ACOSOG Z0011-based recommendations into routine practice at our institution. Between 2011 and 2013, 46.7% of patients who had 1 or 2 positive lymph nodes underwent ALND, while between 2014 and 2016, only 18.2% of patients who had 1 or 2 positive lymph nodes underwent ALND. Table: 242P
| Event | Percentage | |
| LR occurrence | 10-year | 2.15 |
| 5-year | 1.72 | |
| Distant metastasis | 3-year | 3.4 |
| Overall survival | 10-year | 98.7 |
| DFS | 10- and 5-year | 95.3 |
Conclusions
With a follow-up period extending more than five years, our study shows that ALND offers no superiority to SLNB alone in terms of overall survival and disease-free survival. This does not only conform with the findings of z0011 but adds to its generalizability to populations of different ethnicities.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.