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      Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: Long-Term Follow-Up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial

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          Abstract

          Background and Objective

          The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLN) randomized either to axillary lymph node dissection (ALND) or SLN dissection (SLND) alone. We now report long-term locoregional recurrence results.

          Methods

          ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups.

          Results

          Four hundred forty-six patients were randomized to SLND alone and 445 to SLND plus ALND. Both groups were similar with respect to age, Bloom-Richardson score, ER status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared to a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P=0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P=0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P=0.36).

          Conclusion

          Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

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          Author and article information

          Journal
          0372354
          646
          Ann Surg
          Ann. Surg.
          Annals of surgery
          0003-4932
          1528-1140
          8 October 2016
          September 2016
          01 September 2017
          : 264
          : 3
          : 413-420
          Affiliations
          [1 ]Cedars Sinai Medical Center, Los Angeles, CA
          [2 ]Alliance Statistics and Data Center, Weill Cornell Medicine / New York Presbyterian, New York, NY
          [3 ]Alliance Statistics and Data Center, Duke University, Durham, NC
          [4 ]Dallas Surgical Group, Dallas, TX
          [5 ]Nashville Breast Center, Nashville, TN
          [6 ]Morton Plant Hospital, Clear Water, FL
          [7 ]University of Texas Southwestern Medical Center Surgery, Dallas, TX
          [8 ]McLaren Regional Medical Center, Michigan State University, Flint, MI
          [9 ]Memorial Sloan-Kettering Cancer Center, New York, NY
          [10 ]M.D. Anderson Cancer Center, Houston, TX
          Author notes
          Correspondence to: Armando E. Giuliano, MD, Professor of Surgery, Executive Vice-Chair, Surgery, Associate Director, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, 310 N. San Vicente Blvd., Third Floor, Los Angeles, CA 90048, PH: 310-423-9970, FAX: 310-423-9577, Armando.Giuliano@ 123456cshs.org
          Article
          PMC5070540 PMC5070540 5070540 nihpa821701
          10.1097/SLA.0000000000001863
          5070540
          27513155
          Categories
          Article

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