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Importance The results of the American College of Surgeons Oncology Group Z (ACOSOG Z) trial were first reported in with a. The American College of Surgeons Oncology Group (ACOSOG) Z trial was a multicenter noninferiority study which enrolled and. ABSTRACT. Introduction. The ACOSOG Z trial has been described as practice-changing. The goal of this study was to determine the.

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Patients who were lost to follow-up ie, missing data were censored at the time of their last follow-up in the time-to-event analyses disease-free survival and overall survival. Data quality was ensured by review of data by the Alliance Statistics and Data Center and by the study chairperson following Alliance policies. The study was terminated before target enrollment of women because the observed mortality was lower triak anticipated.

Among T breast cancer patients with a positive sentinel lymph node biopsy undergoing lumpectomy acosov whole-breast radiation, does axillary lymph node dissection improve survival or local control compared to nodal observation? Adjuvant systemic therapy was delivered to women The initial study results, reported after a median follow-up of 6. Critical revision of the manuscript for important intellectual content: Design, Setting, and Participants: Hence, the missing data were not associated with outcome.

Like most large randomized trials in breast cancer management, not all biological subtypes are represented in large numbers.

Ten-year regional recurrence did not differ significantly between the 2 groups. Purchase access Subscribe to JN Learning for one year. The American College of Surgeons Oncology Group Z ACOSOG Z randomized clinical trial was designed to determine whether SLND alone yielded survival outcomes that were noninferior to that obtained with ALND in women with a limited number of sentinel node metastases undergoing breast-conserving surgery and receiving adjuvant whole-breast irradiation with adjuvant systemic therapy.

Longer follow-up was necessary because the majority of the patients had estrogen receptor-positive tumors that may recur later in the disease course the ACOSOG is now part of the Alliance for Clinical Trials in Oncology. The protocol specified that patients were to be followed up for a minimum of 10 years.

ACOSOG Z – Wiki Journal Club

The stability of these results over time is important because patients with hormone receptor—positive breast cancer, who comprise the majority of study participants and the majority of breast cancer patients in the United States, are known to be at prolonged risk for disease recurrence.


Breast cancer, particularly hormone receptor—positive breast cancer, is a disease with a long natural history 1112 and a substantial risk of locoregional and systemic relapses occurring after 5 years.

However increased enrollment was unlikely to lead to a meaningful detection in significance, as the majority of axillary recurrence has been shown to occur in the first few years following surgery, the overall local recurrence rates were too low to be meaningfully changed by increased enrollment 0. The study and design end points have been described elsewhere.

Retrieved from ” http: Privacy Policy Terms of Use. No other disclosures were reported. The year overall survival rate was In addition, the unplanned analysis showed that no survival differences were observed among patients treated with conventional tangent-field irradiation or nodal-field aacosog. All other disease sites were defined as distant metastases.

In a multivariable analysis of overall survival, type of treatment was not significantly associated with overall survival Table 3. Sign in to make a comment Sign in to your personal account. Eligible patients were women with clinical T1 or T2 invasive breast cancer, no palpable axillary adenopathy, and 1 or 2 sentinel lymph nodes containing metastases.

Acquisition, analysis, or interpretation of data: Axillary Node Interventions in Breast Cancer. The proportional hazards assumptions for the Cox models were evaluated using Schoenfeld residual plots, and none of the reported models appeared to violate the proportional hazards assumption.

Main Outcomes and Measures: Differences in outcomes may be seen for patients with different individual circumstances.

Consistent with this finding, the incremental decreases in disease-free survival trisl. Locoregional recurrence after breast cancer surgery: Anderson Cancer Center, Houston. At 5 years, there were no differences in terms of overall survival Navigation menu Personal tools Create account Log in. Views Read View source View history. The HR for overall survival adjusting for adjuvant therapy chemotherapy, endocrine therapy, radiation, or a combination of these 3 and age for the SLND alone group compared with the ALND group was 0.

A population-based study of the effects of a regional guideline for completion axillary lymph node dissection on axillary surgery in patients with breast cancer. Axillary lymph node dissection ALND has historically been a means of maintaining regional control of breast cancer, especially in patients with initial presentation of metastatic nodal disease. The National Cancer Institute had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.


The secondary outcome was disease-free survival. Create a free personal account to access your subscriptions, sign up for alerts, and more. Locoregional recurrence was defined as a tumor in the breast or in ipsilateral axillary, internal mammary, subclavicular, or supraclavicular nodes.

Troal in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.

Create a personal account to register for email alerts with links to free full-text articles. Most patients were lost to follow-up because the site investigator left an institution and the institution stopped active follow-up on the patients.

The ongoing Positive Sentinel Node-Adjuvant Therapy Alone vs Adjuvant Therapy Plus Clearance or Axillary Radiotherapy trial for women with metastases in 1 or 2 sentinel nodes treated with breast-conserving surgery or mastectomy will acosov important information about the safety of omitting ALND after mastectomy, but this study is not expected to complete accrual until The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


The Journal of the American Medical Association. In that study, age younger than 50 years and a triple-negative aosog predicted a greater use of ALND, a practice neither supported by the reported 5-year outcomes of ACOSOG Z, 9 nor by the findings of the current report. Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts.

Giuliano AE, et al. Ten years of follow-up confirm that women with 1 or 2 positive sentinel nodes and clinical T1 or T2 tumors undergoing lumpectomy with whole-breast irradiation and systemic therapy experience no worse local control, disease-free survival, or overall survival with elimination of ALND.