Omitting ALND Is Not Safe for a Cohort of Early-Stage Breast Cancer Patients with 1-2 SLNs Macro-Metastases and Breast-Conserving Therapy: A Single-Center Retrospective Study
-
Xiangyu WANG
,
Yinqi GAO
,
Xue YANG
,
Xiangyi KONG
,
Zixing WANG
,
Yi FANG
,
Jing WANG
Abstract
Background: Omitting axillary lymph node dissection (ALND) is recommended for early-stage breast cancer patients with 1-2 sentinel lymph nodes (SLNs) macro-metastases and breast-conserving therapy. However, it is not safe for part of patients, so it is significant to find risk factors and develop a predictive model of non-SLNs metastases in breast cancer patients with 1-2 SLNs macro-metastases and breast-conserving therapy.
Methods: This retrospective study enrolled 228 breast cancer patients with 1-2 SLNs macro-metastases who underwent ALND and breast-conserving surgery between Jan 2012 and Dec 2017 at Cancer Hospital Chinese Academy of Medical Sciences. Chi-square test and backward stepwise binary logistic regression were used to find factors that influenced non-SLN metastases, then a predictive model was formulated and obtained its area under the curve.
Results: Tumor pathologic invasion size, number of positive SLNs and ALN status on imaging was associated with non-SLNs metastases. The predictive model was also formulated based on these three factors to assess and the area under the curve of model was 0.708.
Conclusion: We developed a predictive model to assess the high-risk cohort of patients of non-SLNs metastases which can be an auxiliary tool for doctors.
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3. Gatzemeier W, Mann GB (2013). Which sentinel lymph-node (SLN) positive breast cancer patient needs an axillary lymph-node dissection (ALND)--ACOSOG Z0011 results and beyond. Breast, 22(3):211-6.
4. Boler DE, Uras C, Ince U, et al (2012). Fac-tors predicting the non-sentinel lymph node involvement in breast cancer pa-tients with sentinel lymph node metasta-ses. Breast, 21(4):518-23.
5. Giuliano AE, Ballman KV, McCall L, et al (2017). Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Over-all Survival Among Women With Inva-sive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alli-ance) Randomized Clinical Trial. JAMA, 318(10):918-26.
6. Goyal A, Dodwell D, Reed MW, et al (2014). Axillary treatment in women with one or two sentinel nodes with macrometasta-ses: more evidence is needed to inform practice. J Clin Oncol, 32(34):3902.
7. Voutsadakis IA, Spadafora S (2014). Rec-ommendation for omitting axillary lymph node dissection should be individualized in patients with breast cancer with one or two positive sentinel lymph nodes. J Clin Oncol, 32(34):3901-2.
8. Galimberti V, Cole BF, Zurrida S, et al (2013). Axillary dissection versus no axil-lary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lan-cet Oncol, 14(4):297-305.
9. Weiser MR, Montgomery LL, Tan LK, et al (2001). Lymphovascular invasion en-hances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg On-col, 8(2):145-9.
10. Bolster MJ, Peer PG, Bult P, et al (2007). Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study. Ann Surg Oncol, 14(1):181-9.
11. Asaga S, Kinoshita T, Hojo T, et al (2015). Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients With Clinically Node-Negative Ipsilateral Mul-tiple Breast Cancer Treated With Total Mastectomy. Clin Breast Cancer, 15(5):362-9.
12. Reynolds C, Mick R, Donohue JH, et al (1999). Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast can-cer? J Clin Oncol, 17(6):1720-6.
13. Cho J, Han W, Lee JW, et al (2008). A scor-ing system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a com-parison with other scoring systems. Ann Surg Oncol, 15(8):2278-86.
14. Park HS, Chae BJ, Song BJ, et al (2014). Ef-fect of axillary lymph node dissection af-ter sentinel lymph node biopsy on overall survival in patients with T1 or T2 node-positive breast cancer: report from the Korean Breast Cancer Society. Ann Surg Oncol, 21(4):1231-6.
15. Houvenaeghel G, Bannier M, Nos C, et al (2012). Non sentinel node involvement prediction for sentinel node micrometas-tases in breast cancer: nomogram valida-tion and comparison with other models. Breast, 21(2):204-9.
16. Gur AS, Unal B, Ozbek U, et al (2010). Vali-dation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study. Eur J Surg Oncol, 36(1):30-5.
17. Joseph KA, El-Tamer M, Komenaka I, et al (2004). Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis. Arch Surg, 139(6):648-51.
18. Ozmen V, Karanlik H, Cabioglu N, et al (2006). Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer. Breast Cancer Res Treat, 95(1):1-6.
19. Jinno H, Sakata M, Asaga S, et al (2008). Predictors to assess non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis. Breast J, 14(6):551-5.
20. van den Hoven I, van Klaveren D, Voogd AC, et al (2016). A Dutch Prediction Tool to Assess the Risk of Additional Axillary Non-Sentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients. Clin Breast Cancer, 16(2):123-30.
21. Barranger E, Coutant C, Flahault A, et al (2005). An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat, 91(2):113-9.
22. Alran S, De Rycke Y, Fourchotte V, et al (2007). Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node in-volvement after positive sentinel node biopsy. Ann Surg Oncol, 14(8):2195-201.
23. Meretoja TJ, Audisio RA, Heikkila PS, et al (2013). International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node mac-rometastases. Breast Cancer Res Treat, 138(8):817-27.
24. van Wely BJ, de Wilt JH, Francissen C, et al (2015). Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer. Br J Surg, 102(3):159-68.
25. Choi AH, Blount S, Perez MN, et al (2015). Size of Extranodal Extension on Sentinel Lymph Node Dissection in the American College of Surgeons Oncology Group Z0011 Trial Era. JAMA Surg, 150(12):1141-8.
26. Choi AH, Surrusco M, Rodriguez S, et al (2014). Extranodal extension on sentinel lymph node dissection: why should we treat it differently? Am Surg, 80(10):932-5.
2. Donker M, van Tienhoven G, Straver ME, et al (2014). Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol, 15(12):1303-10.
3. Gatzemeier W, Mann GB (2013). Which sentinel lymph-node (SLN) positive breast cancer patient needs an axillary lymph-node dissection (ALND)--ACOSOG Z0011 results and beyond. Breast, 22(3):211-6.
4. Boler DE, Uras C, Ince U, et al (2012). Fac-tors predicting the non-sentinel lymph node involvement in breast cancer pa-tients with sentinel lymph node metasta-ses. Breast, 21(4):518-23.
5. Giuliano AE, Ballman KV, McCall L, et al (2017). Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Over-all Survival Among Women With Inva-sive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alli-ance) Randomized Clinical Trial. JAMA, 318(10):918-26.
6. Goyal A, Dodwell D, Reed MW, et al (2014). Axillary treatment in women with one or two sentinel nodes with macrometasta-ses: more evidence is needed to inform practice. J Clin Oncol, 32(34):3902.
7. Voutsadakis IA, Spadafora S (2014). Rec-ommendation for omitting axillary lymph node dissection should be individualized in patients with breast cancer with one or two positive sentinel lymph nodes. J Clin Oncol, 32(34):3901-2.
8. Galimberti V, Cole BF, Zurrida S, et al (2013). Axillary dissection versus no axil-lary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lan-cet Oncol, 14(4):297-305.
9. Weiser MR, Montgomery LL, Tan LK, et al (2001). Lymphovascular invasion en-hances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg On-col, 8(2):145-9.
10. Bolster MJ, Peer PG, Bult P, et al (2007). Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study. Ann Surg Oncol, 14(1):181-9.
11. Asaga S, Kinoshita T, Hojo T, et al (2015). Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients With Clinically Node-Negative Ipsilateral Mul-tiple Breast Cancer Treated With Total Mastectomy. Clin Breast Cancer, 15(5):362-9.
12. Reynolds C, Mick R, Donohue JH, et al (1999). Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast can-cer? J Clin Oncol, 17(6):1720-6.
13. Cho J, Han W, Lee JW, et al (2008). A scor-ing system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a com-parison with other scoring systems. Ann Surg Oncol, 15(8):2278-86.
14. Park HS, Chae BJ, Song BJ, et al (2014). Ef-fect of axillary lymph node dissection af-ter sentinel lymph node biopsy on overall survival in patients with T1 or T2 node-positive breast cancer: report from the Korean Breast Cancer Society. Ann Surg Oncol, 21(4):1231-6.
15. Houvenaeghel G, Bannier M, Nos C, et al (2012). Non sentinel node involvement prediction for sentinel node micrometas-tases in breast cancer: nomogram valida-tion and comparison with other models. Breast, 21(2):204-9.
16. Gur AS, Unal B, Ozbek U, et al (2010). Vali-dation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study. Eur J Surg Oncol, 36(1):30-5.
17. Joseph KA, El-Tamer M, Komenaka I, et al (2004). Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis. Arch Surg, 139(6):648-51.
18. Ozmen V, Karanlik H, Cabioglu N, et al (2006). Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer. Breast Cancer Res Treat, 95(1):1-6.
19. Jinno H, Sakata M, Asaga S, et al (2008). Predictors to assess non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis. Breast J, 14(6):551-5.
20. van den Hoven I, van Klaveren D, Voogd AC, et al (2016). A Dutch Prediction Tool to Assess the Risk of Additional Axillary Non-Sentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients. Clin Breast Cancer, 16(2):123-30.
21. Barranger E, Coutant C, Flahault A, et al (2005). An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat, 91(2):113-9.
22. Alran S, De Rycke Y, Fourchotte V, et al (2007). Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node in-volvement after positive sentinel node biopsy. Ann Surg Oncol, 14(8):2195-201.
23. Meretoja TJ, Audisio RA, Heikkila PS, et al (2013). International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node mac-rometastases. Breast Cancer Res Treat, 138(8):817-27.
24. van Wely BJ, de Wilt JH, Francissen C, et al (2015). Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer. Br J Surg, 102(3):159-68.
25. Choi AH, Blount S, Perez MN, et al (2015). Size of Extranodal Extension on Sentinel Lymph Node Dissection in the American College of Surgeons Oncology Group Z0011 Trial Era. JAMA Surg, 150(12):1141-8.
26. Choi AH, Surrusco M, Rodriguez S, et al (2014). Extranodal extension on sentinel lymph node dissection: why should we treat it differently? Am Surg, 80(10):932-5.
| Files | ||
| Issue | Vol 49 No 7 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v49i7.3579 | |
| PMCID | PMC7548499 | |
| PMID | 33083292 | |
| Keywords | ||
| Breast cancer; Risk-factors; Predictive model; Macro-metastases; Breast-conserving surgery | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
WANG X, GAO Y, YANG X, KONG X, WANG Z, FANG Y, WANG J. Omitting ALND Is Not Safe for a Cohort of Early-Stage Breast Cancer Patients with 1-2 SLNs Macro-Metastases and Breast-Conserving Therapy: A Single-Center Retrospective Study. Iran J Public Health. 2020;49(7):1262-1268.
