Omission of completion axillary lymph-node dissection (ALND) has been shown to mitigate lymphoedema without compromising survival outcomes in patients with clinically node-negative (cN0) breast cancer who have nodal metastasis detected upon sentinel lymph-node biopsy (SLNB), albeit in trials with limited statistical power and clinical representativeness. Now, data from the phase III SENOMAC trial in a larger and more representative cohort support the noninferiority of a SLNB-only approach.

The per-protocol population comprised 2,540 patients with cT1–3cN0 breast cancer and 1–2 SLNB-detected macrometastases (largest dimension >2 mm), of whom 1,205 were randomly assigned to undergo ALND. Most patients received postoperative radiotherapy (~89% in each group) and systemic therapy (~99%) according to local guidelines. Overall survival (OS) was the primary end point, and secondary end points included breast cancer-specific survival (BCSS) and recurrence-free survival (RFS).

对于在前哨淋巴结活检 (SLNB) 中检测到淋巴结转移的临床淋巴结阴性 (cN0) 乳腺癌患者，省略完成性腋窝淋巴结清扫 (ALND) 已被证明可以减轻淋巴水肿，且不会影响生存结果。统计能力和临床代表性有限的试验。现在，来自规模更大且更具代表性的队列的 III 期 SENOMAC 试验的数据支持仅 SLNB 方法的非劣效性。

符合方案的人群包括 2,540 名患有 cT1-3cN0 乳腺癌和 1-2 例 SLNB 检测到的宏观转移（最大尺寸 >2 mm）的患者，其中 1,205 名被随机分配接受 ALND。大多数患者根据当地指南接受术后放疗（每组约 89%）和全身治疗（约 99%）。总生存期（OS）是主要终点，次要终点包括乳腺癌特异性生存期（BCSS）和无复发生存期（RFS）。