Therapeutic role of axillary lymph node dissection in patients with stage IV breast cancer: a population-based analysis

Construction and Validation of a Novel Nomogram for Predicting the Risk of Metastasis in a Luminal B Type Invasive Ductal Carcinoma Population

Background

Postoperative distant metastasis is the main cause of death in breast cancer patients. We aimed to construct a nomogram to predict the risk of metastasis of luminal B type invasive ductal carcinoma.

Methods

We applied the data of 364 luminal B type breast cancer patients between 2008 and 2013. Patients were categorized into modeling group and validation group randomly (1:1). The breast cancer metastasis nomogram was developed from the logistic regression model using clinicopathological variables. The area under the receiver-operating characteristic curve (AUC) was calculated in modeling group and validation group to evaluate the predictive accuracy of the nomogram.

Results

The multivariate logistic regression analysis showed that tumor size, No. of the positive level 1 axillary lymph nodes, human epidermal growth factor receptor 2 (HER2) status and Ki67 index were the independent predictors of the breast cancer metastasis. The AUC values of the modeling group and the validation group were 0.855 and 0.818, respectively. The nomogram had a well-fitted calibration curve. The positive and negative predictive values were 49.3% and 92.7% in the modeling group, and 47.9% and 91.0% in the validation group. Patients who had a score of 60 or more were thought to have a high risk of breast cancer metastasis.

Conclusions

The nomogram has a great predictive accuracy of predicting the risk of breast cancer metastasis. If patients had a score of 60 or more, necessary measures, like more standard treatment methods and higher treatment adherence of patients, are needed to take to lower the risk of metastasis and improve the prognosis.

Nanocarbon Tracer and Areola Injection Site Are Superior in the Sentinel Lymph Node Biopsy Procedure for Breast Cancer

Background. Axillary lymph node (ALN) staging is the most effective method to evaluate the condition of patients with breast cancer, their choice of treatment options, and prognosis. The sentinel lymph node (SLN) status assessment is the key to sentinel lymph node biopsy (SLNB) in patients with breast cancer. The choice of tracer and tracer injection sites affects SLNB. Objective. This study mainly analyzes the best tracer for SLNB and the best choice of tracer injection site. Methods. A total of 165 breast cancer patients who underwent SLNB were selected and injected with methylene blue or 99mTc-labeled sodium phytate or nanocarbon 20 min before biopsy. The number of SLNs detected by different tracers in different injection sites such as peritumoral tissue (PT) and subareolar area (SA) was counted, and the sensitivity, specificity, and positive/negative prediction rates were recorded and compared. Results. The detection success rate, average detection number of SLNs, and detection accuracy of the nanocarbon tracer were higher than the other two. The detection sensitivity, specificity, and positive and negative prediction rates of nanocarbon for SLNB were also higher than those of the other two tracers. When comparing the performance of tracers in different injection sites, it was found that the detection of three tracers injected in the SA was better than the injection in the PT. Conclusion. For women with early-stage breast cancer, nanocarbon can be used as the preferred tracer for SLNB to determine the status of the patient’s ALNs, and the areola area can be used as the best injection site.

Axillary surgical approach in metastatic breast cancer patients: a systematic review and meta-analysis

A systematic review and meta-analysis were conducted to evaluate the benefit of an axillary surgical approach on overall survival and secondarily of breast surgery amongst patients with metastatic breast cancer which is considered to be an incurable disease. However, an axillary surgical approach showed no association with overall survival in patients with metastatic breast cancer. The true impact of locoregional therapies on long-term outcomes remains unknown, and randomised clinical trials are needed.

Survival benefit of radiotherapy after surgery in de novo stage IV breast cancer: a population-based propensity-score matched analysis

The survival benefit from radiotherapy in stage IV breast cancer has not been fully evaluated. We investigated the survival benefit of radiotherapy after surgery in de novo stage IV breast cancer. Using a population-based database (the Surveillance, Epidemiology, and End Results database 18, 2010-2013), patients diagnosed with de novo stage IV breast cancer were divided into those undergoing surgery alone (no-radiotherapy group) and those undergoing surgery followed by radiotherapy (radiotherapy group). After propensity-score matching (PSM), the cancer-specific survival (CSS) rates were estimated. Multivariate analysis was performed to evaluate the prognostic value of radiotherapy on survival. After PSM, the 3-year CSS rates in the no-radiotherapy (n = 882) and radiotherapy (n = 882) groups were 57.1% and 70.9% (P < 0.001), respectively. On multivariate analysis, radiotherapy after surgery was a significant prognosticator (hazard ratio [HR] 0.572; 95% confidence interval [CI] 0.472-0.693, P < 0.001). Regardless of surgery type and lymph node involvement, the radiotherapy group showed significantly higher CSS rates. For patients who survived six months or more, radiotherapy after surgery demonstrated favorable prognosis compared to surgery alone (HR 0.593; 95% CI 0.479-0.733, P < 0.001). In conclusion, radiotherapy after surgery increased CSS rates in de novo stage IV breast cancer compared to surgery alone.