Factors associated with local-regional recurrence after a negative sentinel node dissection: Results of the ACOSOG Z0010 trial Journal Article


Authors: Hunt, K. K.; Ballman, K. V.; McCall, L. M.; Boughey, J. C.; Mittendorf, E. A.; Cox, C. E.; Whitworth, P. W.; Beitsch, P. D.; Leitch, A. M.; Buchholz, T. A.; Morrow, M. A.; Giuliano, A. E.
Article Title: Factors associated with local-regional recurrence after a negative sentinel node dissection: Results of the ACOSOG Z0010 trial
Abstract: Objective: To determine factors important in local-regional recurrence (LRR) in patients with negative sentinel lymph nodes (SLNs) by hematoxylin and eosin (H&E) staining. Background: Z0010 was a prospective multicenter trial initiated in 1999 by the American College of Surgeons Oncology Group to evaluate occult disease in SLNs and bone marrow of early-stage breast cancer patients. Participants included women with biopsy-proven T1-2 breast cancer with clinically negative nodes, planned for lumpectomy and whole breast irradiation. Methods: Women with clinical T1-2,N0,M0 disease underwent lumpectomy and SLN dissection. There was no axillary-specific treatment for H&E-negative SLNs, and clinicians were blinded to immunohistochemistry results. Systemic therapy was based on primary tumor factors. Univariable and multivariable analyses were performed to determine clinicopathologic factors associated with LRR. Results: Of 5119 patients, 3904 (76.3%) had H&E-negative SLNs. Median age was 57 years (range 23-95). At median follow-up of 8.4 years, there were 127 local, 20 regional, and 134 distant recurrences. Factors associated with local-regional recurrence were hormone receptor-negative disease (P = 0.0004) and younger age (P = 0.047). In competing risk-regression models, hormone receptor-positive disease and use of chemotherapy were associated with reduction in local-regional recurrence. When local recurrence was included in the model as a time-dependent variable, older age, T2 disease, high tumor grade, and local recurrence were associated with reduced overall survival. Conclusions: Local-regional recurrences are rare in early-stage breast cancer patients with H&E-negative SLNs. Younger age and hormone receptor-negative disease are associated with higher event rates, and local recurrence is associated with reduced overall survival. © 2012 Lippincott Williams & Wilkins.
Keywords: immunohistochemistry; adult; cancer chemotherapy; cancer survival; aged; major clinical study; overall survival; clinical feature; cancer recurrence; cancer risk; systemic therapy; conference paper; cancer adjuvant therapy; cancer radiotherapy; follow up; lymph node dissection; cancer grading; sentinel lymph node; sentinel lymph node biopsy; breast cancer; distant metastasis; early cancer; multicenter study; partial mastectomy; eosin; hematoxylin; age distribution; estrogen receptor; progesterone receptor; local metastasis; regional metastasis; local-regional recurrence; local regional recurrence
Journal Title: Annals of Surgery
Volume: 256
Issue: 3
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2012-09-01
Start Page: 428
End Page: 436
Language: English
DOI: 10.1097/SLA.0b013e3182654494
PROVIDER: scopus
PUBMED: 22868365
PMCID: PMC5345746
DOI/URL:
Notes: --- - "Export Date: 1 October 2012" - "CODEN: ANSUA" - "Source: Scopus"
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  1. Monica Morrow
    725 Morrow