Abstract
Purpose
The ACOSOG-Z0011-study has resulted in a trend to a more conservative treatment of
the axilla for selected sentinel-node-positive patients. However, axillary nodal involvement
has always been an important factor for tumor staging and tailoring adjuvant chemotherapy
plans. This study evaluates the impact of omitting completion axillary lymph node
dissection (cALND) on the administration of adjuvant chemo (-immuno)therapy in Dutch
clinical T1-2N0M0 (cT1-2N0M0) sentinel-node-positive breast cancer patients.
Methods
Data were obtained from the nationwide NABON breast cancer audit. Descriptive analyses
were used to demonstrate trends in axillary surgery and adjuvant chemo (-immuno)therapy.
Multivariable logistic regression analyses were used to identify factors associated
with the prescription of chemo (-immuno)therapy.
Results
In this cohort of 4331 patients, the omission of a cALND increased from 34% to 92%,
and the administration of chemo (-immuno)therapy decreased from 68% to 55%, between
2011 and 2015 (P < 0.001). Patients treated with cALND had an OR of 2.2 for receiving adjuvant chemo
(-immuno)therapy compared with SLNB only patients. Lower age, a hormone receptor (HR)
status other than HR-positive, HER2-negative, increasing tumor grade and stage, and
a lymph node status ≥ pN2 were independently associated with a higher probability
of chemo (-immuno)therapy (P < 0.05).
Conclusions
This study showed that Dutch cT1-2N0M0 sentinel node-positive breast cancer patients
treated with cALND had a higher independent probability for receiving adjuvant chemo
(-immuno)therapy compared with SLNB only patients, even when corrected for lymph node
status and HR-status. Probably, the decisions to administer adjuvant chemo (-immuno)therapy
were not only based on guidelines and tumor characteristics, but also on the preferences
from physicians and patients.
Keywords
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References
- Trends on axillary surgery in nondistant metastatic breast cancer patients treated between 2011 and 2015: a Dutch population-based study in the ACOSOG-Z0011 and AMAROS era.Ann Surg. 2017; ([Epub ahead of print])
- Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy.Ann Surg Oncol. 2009; 16: 687-696
- Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial.Ann Surg. 2010; 252 (discussion 32–33): 426-432
- Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial.Ann Surg. 2016; 264: 413-420
- Controversies in breast cancer: adjuvant and neoadjuvant therapy.Expet Opin Pharmacother. 2005; 6: 1055-1072
- Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.Cancer. 1989; 63: 181-187
Nationaal Borstkanker Overleg Nederland (NABON). Richtlijn behandeling van het mammacarcinoom. editorˆ, editors". City; Accessed 2 March 2012.
- Role of patient and disease factors in adjuvant systemic therapy decision making for early-stage, operable breast cancer: american society of clinical oncology endorsement of cancer care ontario guideline recommendations.J Clin Oncol. 2016; 34: 2303-2311
- De-escalation of axillary surgery in early breast cancer.Lancet Oncol. 2016; 17: e430-e441
- Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: american society of clinical oncology clinical practice guideline focused update.J Clin Oncol. 2017; 35: 2838-2847
- Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.J Am Med Assoc. 2011; 305: 569-575
- Tailoring therapies–improving the management of early breast cancer: st Gallen international expert consensus on the primary therapy of early breast cancer 2015.Ann Oncol. 2015; 26: 1533-1546
- Clinical auditing as an instrument for quality improvement in breast cancer care in The Netherlands: the national NABON Breast Cancer Audit.J Surg Oncol. 2017; 115: 243-249
- Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level.Breast Cancer Res Treat. 2016; 159: 357-365
- 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. 2014; 15: 1303-1310
- Role of axillary clearance after a tumor-positive sentinel node in the administration of adjuvant therapy in early breast cancer.J Clin Oncol. 2010; 28: 731-737
- Eight-year follow up result of the OTOASOR trial: the Optimal Treatment of the Axilla - surgery or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial.Eur J Surg Oncol. 2017; 43: 672-679
- Omission of axillary dissection after a positive sentinel lymph-node: implications in the multidisciplinary treatment of operable breast cancer.Canc Treat Rev. 2016; 48: 1-7
- Omission of axillary dissection according to ACOSOG Z0011: impact on adjuvant treatment recommendations.Ann Surg Oncol. 2013; 20: 1538-1544
- Omission of axillary dissection after a positive sentinel node dissection may influence adjuvant chemotherapy indications in operable breast cancer patients.Ann Surg Oncol. 2012; 19: 3755-3761
- How important is the axillary nodal status for adjuvant treatment decisions at a breast cancer multidisciplinary tumor board? A survival analysis.Ann Surg Oncol. 2008; 15: 472-477
- Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status.Psychother Psychosom. 2008; 77: 219-226
- American cancer society/American society of clinical oncology breast cancer survivorship care guideline.J Clin Oncol. 2016; 34: 611-635
- Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients.Br J Cancer. 2003; 89: 648-652
- Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.Lancet Oncol. 2013; 14: 500-515
- Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis.Pain. 2014; 155: 2461-2470
- Long term side effects of adjuvant chemotherapy in patients with early breast cancer.Breast. 2015; 24: S149-S153
- 70-Gene signature as an aid to treatment decisions in early-stage breast cancer.N Engl J Med. 2016; 375: 717-729
- Impact of gene-expression profiling in patients with early breast cancer when applied outside the guideline directed indication area.Eur J Cancer. 2017; 84: 270-277
- Assessing bias: the importance of considering confounding.Evid Base Spine Care J. 2012; 3: 9-12
Article info
Publication history
Published online: March 14, 2018
Accepted:
March 5,
2018
Identification
Copyright
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
