![]() Another study from 2010 to 2016 in five hospitals compared ALND with SLBx only in a Z0011-eligible cohort of 1,750 patients with one or two sentinel lymph node metastases. Adding ALND after SLBx did not improve the overall survival rate. ![]() A total of 2,581 patients were enrolled from January 2001 to April 2011 in 110 hospitals. In 2014, investigators evaluated the effect of SLBx and ALND on survival rate in cases of T1, T2, and node-positive patients. This approach has precedence in Korea through multicenter studies. It was concluded that Z0011 criteria could be safely applied in high-risk breast cancer. There was no difference in survival rate between ALND and SLBx only groups in high-risk breast cancer patients. Another study evaluated patients with high-risk breast cancer (triple negative or human epidermal growth factor receptor 2 positive breast cancer or diagnosed before the age of 40 years). More than 80% of patients in the Z0011 trial were hormone receptor-positive. A study in Canada compared cases that met the Z0011 criteria as classified into three groups (before Z0011 publication, after publication, and after guideline dissemination) and found that the proportion of patients undergoing ALND gradually decreased (82% before publication, 58% after publication, and 39% after guideline dissemination). After the Z0011 criteria were published, several multifaceted approaches were taken to verify that the criteria could be applied safely.
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