The Prognostic Significance of Further Axillary Dissection for Sentinel Lymph Node Micrometastases in Female Breast Cancer: A Competing Risk Analysis using the SEER Database

Abstract On the basis of the Surveillance, Epidemiology, and End Results (SEER) database, the aim of this study is to identify whether complete axillary lymph node dissection (ALND) is actually required and has an impact on breast cancer-specific survival (BCSS) and overall survival (OS) in breast cancer patients with micrometastases. We identified 13,848 women whose nodal status was micrometastases (pTxN1miM0) were classified into two groups: the sentinel lymph node biopsy (SLNB) only group and SLNB with complete ALND group. After the PSM, we found that the SLNB with complete ALND showed no significant difference in OS (HR = 1.04, 95% CI: 0.84–1.28, P = 0.73) or BCSS (HR = 1.03, 95% CI: 0.79–1.35, P = 0.82) compared to the SLNB only group. There was no statistically significant difference in the cumulative incidence of BCSD (Grey’s test, P = 0.819) or OCSD (Grey’s test, P = 0.788) for between the two groups either. Our results suggest that in early breast cancer patients with micrometastasis, complete ALND does not seem to be required and that SLNB suffices to control locoregional and distant disease, with no significant adverse effects on survival compared to complete ALND.