1
|
Kustić D. Size of Extranodal Extension in the Sentinel Lymph Node as a Predictor of Prognosis in Early-Stage Breast Cancer. Clin Breast Cancer 2024:S1526-8209(24)00118-6. [PMID: 38871577 DOI: 10.1016/j.clbc.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION The presence of extranodal extension (ENE) in sentinel lymph nodes (SLNs) can predict non-SLN metastases in breast cancer (BC) patients; however, the prognostic relevance of its extent remains controversial. The purpose of this study was to examine the predictive role of ENE in SLNs measured by its widest dimension (WD), highest dimension (HD), and the WD/HD ratio for non-SLN involvement, overall, and disease-free survival (OS, DFS) in cT1-2N0 BC patients with positive SLNs. MATERIALS AND METHODS A total of 511 women with cT1-2N0 BC and positive SLNs undergoing axillary lymph node dissection were retrospectively enrolled. The associations of ENE's WD, HD, and WD/HD ratio with non-SLN metastases, 5-year OS, and DFS were established through a multivariable modeling approach. RESULTS SLNs were ENE-positive in 149 (29.16%) participants, and 133 (26.03%) had non-SLN metastases. During the median 60 (16-60)-month follow-up, 69 (13.50%) patients experienced recurrences, and 62 (12.13%) died. The numbers of SLNs, non-SLNs, and total axillary LNs involved differed between the ENE-negative and ENE-positive groups, as well as between the WD/HD ≤ 1.2 and WD/HD > 1.2 subgroups (all P-values were < .001). Multivariable analyses showed significant associations of the WD/HD ratio > 1.2 with non-SLN involvement, OS, and DFS (P-values were .003, < .001, and .005, respectively). DISCUSSION Despite no predictive value of ENE's WD and HD, the WD/HD ratio > 1.2 was an independent predictor of non-SLN involvement, mortality, and recurrence. ENE's WD/HD ratio could be a valuable indicator for cT1-2N0 BC individuals with positive SLNs for whom further axillary treatment may be beneficial.
Collapse
Affiliation(s)
- Domagoj Kustić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| |
Collapse
|
2
|
Identification of Risk Factors Associated with Axillary Lymph Node Metastasis for Sentinel Lymph Node-Positive Breast Cancer Patients. JOURNAL OF ONCOLOGY 2021; 2020:8884337. [PMID: 33456464 PMCID: PMC7785375 DOI: 10.1155/2020/8884337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/02/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
Objective This study aimed to identify clinicopathological factors related to the extent of axillary lymph node (ALN) involvement in early-stage BC patients with positive sentinel lymph nodes (SLNs). Methods This was a retrospective analysis of 566 patients in cT1-2N0M0 with 1-2 positive SLNs that underwent axillary lymph node dissection (ALND) at Sun Yat-Sen Memorial Hospital. The clinical and pathologic data from these patients were analyzed. Results Of these 566 patients, 235 (41.5%) exhibited NSLN metastases. Multivariate analysis revealed that the number of positive SLNs (odds ratio (OR) = 1.511; P=0.038), the ratio of metastatic/dissected SLNs (SLN metastasis rate) (OR = 2.124; P < 0.001), and lymphovascular invasion (LVI) (OR = 1.503; P=0.022) were all independent predictors of NSLN metastasis. Patients with 0, 1, 2, or 3 of these risk factors exhibited NSLN metastases in 29.3%, 35.7%, 50.8%, and 68.3% of cases, respectively. We additionally found that the number of positive SLNs (OR = 3.582; P < 0.001), SLN metastasis rate (OR = 2.505; P=0.001), LVI (OR = 2.010; P=0.004), and HER2 overexpression (OR = 1.774; P=0.034) were all independent predictors of N2 disease. When individuals had 0, 1, 2, 3, or 4 of these risk factors, they had four or more involved ALNs in 5.2%, 10.8%, 21.1%, 37.5%, and 70.6% of cases, respectively. Conclusion These results suggest that the number of positive SLNs, the SLN metastasis rate, and LVI are all significant predictors of ALN status in BC patients that have 1-2 positive SLNs and that have undergone ALND. In addition, HER2 overexpression was a significant predictor of N2 disease.
Collapse
|
3
|
Chang DW, Bressel M, Hansen C, Blinman P, Schofield P, Chua BH. Axillary dissection in sentinel lymph node positive breast cancer: Is the staging information worthwhile for patients? Asia Pac J Clin Oncol 2019; 17:e27-e34. [PMID: 31461222 DOI: 10.1111/ajco.13238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 08/04/2019] [Indexed: 12/18/2022]
Abstract
AIMS The Z0011 randomized trial demonstrated no significant difference in axillary recurrence rate or survival with or without axillary dissection in patients with a positive sentinel node biopsy. However, there is continuing controversy regarding the generalizability of its results, and axillary dissection provides additional pathologic staging information that may guide adjuvant therapy. Thus, axillary dissection after positive sentinel node biopsy is being further investigated in an actively recruiting randomized trial. We elicited patients' preferences for axillary dissection versus no axillary dissection after positive sentinel node biopsy for early breast cancer. METHODS Patients who had undergone axillary dissection after positive sentinel node biopsy as part of breast conserving therapy were provided with a validated, self-rated questionnaire. The questionnaire comprised two trade-off questions to determine the maximum chance of developing arm side-effects from axillary dissection to justify the benefit of additional axillary staging information. Social, demographic, and clinical details were collected. RESULTS Ninety-nine of the 126 eligible patients returned the questionnaire and 76 completed the trade-off assessment. The median age of participants was 62 years. The median numbers of sentinel and axillary nodes removed were 2 and 12, respectively. Forty-seven percent of participants had arm swelling or tenderness of any severity. Seventy-five percent of participants would have axillary dissection even if the chance of arm side-effects like they had experienced was 100%. CONCLUSION Most patients with early breast cancer preferred axillary dissection after positive sentinel node biopsy for the additional staging information even though there was no survival benefit from axillary dissection.
Collapse
Affiliation(s)
- David W Chang
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carmen Hansen
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prunella Blinman
- Concord Cancer Centre, Hospital Road, Concord, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Victoria, Australia.,Behavioural Sciences Unit, Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Boon H Chua
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Poodt IG, Rots ML, Vugts G, van Dalen T, Kuijer A, Vriens BE, Nieuwenhuijzen GA, Schipper RJ. The administration of adjuvant chemo(-immuno) therapy in the post ACOSOG-Z0011 era; a population based study. Eur J Surg Oncol 2018; 44:1151-1156. [DOI: 10.1016/j.ejso.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022] Open
|
5
|
Cremades M, Torres M, Solà M, Navinés J, Pascual I, Mariscal A, Caballero A, Castellà E, Luna MÁ, Julián JF. Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. Cir Esp 2017; 95:536-541. [PMID: 29033071 DOI: 10.1016/j.ciresp.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.
Collapse
Affiliation(s)
- Manel Cremades
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España.
| | - Mireia Torres
- Cirugía General y Digestiva, Hospital General de Catalunya, Sant Cugat del Vallés, España
| | - Montse Solà
- Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona
| | - Jordi Navinés
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Icíar Pascual
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | | | - Albert Caballero
- Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, España
| | - Eva Castellà
- Anatomía Patológica, Hospital Germans Trias i Pujol, Badalona, España
| | - Miguel Ángel Luna
- Ginecología y Obstetricia, Hospital Germans Trias i Pujol, Badalona, España
| | | |
Collapse
|
6
|
Houvenaeghel G, Lambaudie E, Cohen M, Classe JM, Reyal F, Garbay JR, Giard S, Chopin N, Martinez A, Rouzier R, Daraï E, Colombo PE, Coutant C, Gimbergues P, Azuar P, Villet R, Tunon de Lara C, Barranger E, Sabiani L, Goncalves A. Therapeutic escalation - De-escalation: Data from 15.508 early breast cancer treated with upfront surgery and sentinel lymph node biopsy (SLNB). Breast 2017; 34:24-33. [PMID: 28475932 DOI: 10.1016/j.breast.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/21/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to examine changes in therapeutic practices for early breast cancer T0-2 N0 managed by upfront surgery and SLNB. POPULATION Between 1999 and 2012, 15.508 patients were treated. Four periods were determined: 1999-2003, 2004-2006, 2007-2009 and > 2009. Five tumor subtypes were defined according to hormonal receptors (HR) and Her2: Luminal A (HR + Her2- Grade 1-2), Her2 (Her2+ HR-), Triple-negative (HR- Her2-), Luminal B Her2- (HR + Her2- Grade 3), Luminal B Her2+ (HR + HER2+). METHODS Rates of axillary lymph node dissection (ALND), adjuvant chemotherapy ± trastuzumab, endocrine treatment, mastectomy and post mastectomy radiotherapy (PMRT) were analyzed according to treatment periods with univariate and multivariate analysis. Overall and disease-free survivals were analyzed according to treatment periods adjusted for HR and then for tumor subtypes. RESULTS Rates of ALND, adjuvant chemotherapy and endocrine treatment varied significantly according to treatment periods, for HR positive and negative tumors. ALND rate decreased for all tumor subtypes with a decrease of adjuvant chemotherapy rate for Luminal A tumors and an increase for Luminal B Her2+ and Her2-tumors. Endocrine treatment rate decreased for Luminal A and increased for Luminal B Her2+ tumors. In multivariate analysis, these modifications with time remained significant. Mastectomy and PMRT rates increased. In multivariate analysis, overall and disease-free survivals increased during successive periods. CONCLUSION A global therapeutic de-escalation in ALND and adjuvant systemic treatment, combined with an actual escalation in some specific subsets was demonstrated, but without negative impact on survival.
Collapse
Affiliation(s)
- Gilles Houvenaeghel
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Faculté Timone, 25 Boulevard Jean Moulin, Marseille, France.
| | - Eric Lambaudie
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
| | - Monique Cohen
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
| | - Jean-Marc Classe
- Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France
| | - Fabien Reyal
- Institut Curie, 26 Rue d'Ulm 75248, Paris, France
| | - Jean-Rémy Garbay
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Sylvia Giard
- Centre Oscar Lambret, 3 Rue Frédéric Combenal, Lille, France
| | | | - Alejandra Martinez
- Centre Institut Claudius Regaud Claudius Regaud, 20-24 Rue du Pont St Pierre, Toulouse, France
| | - Roman Rouzier
- Centre René Huguenin, 35 Rue Dailly, Saint Cloud, France
| | - Emile Daraï
- Hôpital Tenon, 4 Rue de la Chine, Paris, France
| | | | - Charles Coutant
- Centre Georges François Leclerc, 1 Rue du Professeur Marion, Dijon, France
| | | | - Pierre Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - Richard Villet
- Hôpital des Diaconnesses, 18 Rue du Sergent Bauchat, Paris, France
| | | | | | | | - Anthony Goncalves
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Faculté Timone, 25 Boulevard Jean Moulin, Marseille, France
| |
Collapse
|