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Wu N, Su X, Tan Q, Luo J, Yuan Y, Hou L, Li J. Comparison of survival outcomes between axillary conservation and axillary lymph node dissections in N1 early breast cancer: a propensity-matched SEER analysis. Clin Transl Oncol 2023; 25:1091-1101. [PMID: 36515887 PMCID: PMC10025184 DOI: 10.1007/s12094-022-03017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sentinel lymph node dissection (SLND) is an alternative to axillary lymph node dissection (ALND) for breast cancer surgery. But the criteria of SLND only for patients with limited disease in the sentinel node is disputed. METHODS From the Surveillance, Epidemiology, and End Results (SEER) database, 2000-2015, we identified 97,296 early breast cancer females with 1-3 axillary lymph nodes macro-metastasis. Of them, 1-5 (axillary conservation group), 6-9, and ≥ 10 (ALND group) axillary lymph nodes were dissected in 28,639, 16,838, and 51,819 patients, respectively. According to the criteria of the ACOSOG Z0011 trial, two historical cohort studies of patients who underwent lumpectomy or mastectomy were conducted and the survival outcomes between ALND and axillary conservation were compared. RESULTS Overall, dissection of 6-9 regional lymph nodes resulted in the worst prognosis. After propensity-matched analysis, it was found that patients in the axillary conservation group had worse survival than the ALND group in overall survival. No significant difference in prognosis between the group undergoing lumpectomy was found both in OS and BCSS. Subgroup analysis revealed that Grade 3, T2, two lymph nodes positive, or Her2 positive were the main causes of worse survival in the axillary conservation group. CONCLUSION Not all patients with N1 early breast cancer suit axillary conservation. Axillary conservation was sufficient in patients who were treated with lumpectomy. ALND cannot be omitted in patients who were ineligible for the Z0011 and undergoing mastectomy with the following characteristics: T2, Grade 3, two positive lymph nodes, and Her2 positive, which may be better complemented to the Z0011 trial. Hence, under different surgical methods, the clinical precision treatment of ALND or axillary preservation is essential.
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Affiliation(s)
- Nisha Wu
- Academician (Expert) Workstation, Sichuan Key Laboratory of Medical Imaging, Department of Biological Targeting Laboratory of Breast Cancer, Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, 1# Maoyuan Road South, Shunqing District, Nanchong, 637000, Sichuan, China
- Department of Clinical Laboratory, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohan Su
- Academician (Expert) Workstation, Sichuan Key Laboratory of Medical Imaging, Department of Biological Targeting Laboratory of Breast Cancer, Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, 1# Maoyuan Road South, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Qiao Tan
- Academician (Expert) Workstation, Sichuan Key Laboratory of Medical Imaging, Department of Biological Targeting Laboratory of Breast Cancer, Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, 1# Maoyuan Road South, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China
| | - Yewei Yuan
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China
| | - Lingmi Hou
- Academician (Expert) Workstation, Sichuan Key Laboratory of Medical Imaging, Department of Biological Targeting Laboratory of Breast Cancer, Breast and Thyroid Surgery, Affiliated Hospital of North Sichuan Medical College, 1# Maoyuan Road South, Shunqing District, Nanchong, 637000, Sichuan, China.
- Department of General Surgery, Yingshan Hospital, Southwest Hospital of Sichuan University, Nanchong, Sichuan, China.
| | - Junyan Li
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, No. 290 West Second Street, Shayan Road, Chengdu, 610031, Sichuan, China.
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Núñez NG, Tosello Boari J, Ramos RN, Richer W, Cagnard N, Anderfuhren CD, Niborski LL, Bigot J, Meseure D, De La Rochere P, Milder M, Viel S, Loirat D, Pérol L, Vincent-Salomon A, Sastre-Garau X, Burkhard B, Sedlik C, Lantz O, Amigorena S, Piaggio E. Tumor invasion in draining lymph nodes is associated with Treg accumulation in breast cancer patients. Nat Commun 2020; 11:3272. [PMID: 32601304 PMCID: PMC7324591 DOI: 10.1038/s41467-020-17046-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Tumor-draining lymph node (TDLN) invasion by metastatic cells in breast cancer correlates with poor prognosis and is associated with local immunosuppression, which can be partly mediated by regulatory T cells (Tregs). Here, we study Tregs from matched tumor-invaded and non-invaded TDLNs, and breast tumors. We observe that Treg frequencies increase with nodal invasion, and that Tregs express higher levels of co-inhibitory/stimulatory receptors than effector cells. Also, while Tregs show conserved suppressive function in TDLN and tumor, conventional T cells (Tconvs) in TDLNs proliferate and produce Th1-inflammatory cytokines, but are dysfunctional in the tumor. We describe a common transcriptomic signature shared by Tregs from tumors and nodes, including CD80, which is significantly associated with poor patient survival. TCR RNA-sequencing analysis indicates trafficking between TDLNs and tumors and ongoing Tconv/Treg conversion. Overall, TDLN Tregs are functional and express a distinct pattern of druggable co-receptors, highlighting their potential as targets for cancer immunotherapy.
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Affiliation(s)
- Nicolas Gonzalo Núñez
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
- Institute of Experimental Immunology, University of Zurich, Winterthurerstr. 190, CH-8057, Zurich, Switzerland
| | | | - Rodrigo Nalio Ramos
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
| | - Wilfrid Richer
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
| | - Nicolas Cagnard
- Paris-Descartes Bioinformatics Platform, 75015, Paris, France
| | - Cyrill Dimitri Anderfuhren
- Institute of Experimental Immunology, University of Zurich, Winterthurerstr. 190, CH-8057, Zurich, Switzerland
| | | | - Jeremy Bigot
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
| | - Didier Meseure
- Institut Curie, PSL Research University, Departement de Biologie des Tumeurs, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | | | - Maud Milder
- Institut Curie, PSL Research University, Departement de Biologie des Tumeurs, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | - Sophie Viel
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
| | - Delphine Loirat
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
- Institut Curie, PSL Research University, Departement d'Oncologie Medicale, F-75005, Paris, France
| | - Louis Pérol
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
| | - Anne Vincent-Salomon
- Institut Curie, PSL Research University, Departement de Biologie des Tumeurs, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | - Xavier Sastre-Garau
- Institut Curie, PSL Research University, Departement de Biologie des Tumeurs, F-75005, Paris, France
- Institut de Cancerologie de Lorraine Department of Biopathology, 6, avenue de Bourgogne CS 30519, 54519, Vandoeuvre-lès-Nancy cedex, France
| | - Becher Burkhard
- Institute of Experimental Immunology, University of Zurich, Winterthurerstr. 190, CH-8057, Zurich, Switzerland
| | - Christine Sedlik
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | - Olivier Lantz
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
- Institut Curie, PSL Research University, Departement de Biologie des Tumeurs, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | - Sebastian Amigorena
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France
| | - Eliane Piaggio
- Institut Curie, PSL Research University, INSERM U932, F-75005, Paris, France.
- Centre d'Investigation Clinique Biotherapie CICBT 1428, Institut Curie, Paris, F-75005, France.
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Di Filippo F, Di Filippo S, Ferrari AM, Antonetti R, Battaglia A, Becherini F, Bernet L, Boldorini R, Bouteille C, Buglioni S, Burelli P, Cano R, Canzonieri V, Chiodera P, Cirilli A, Coppola L, Drago S, Di Tommaso L, Fenaroli P, Franchini R, Gianatti A, Giannarelli D, Giardina C, Godey F, Grassi MM, Grassi GB, Laws S, Massarut S, Naccarato G, Natalicchio MI, Orefice S, Palmieri F, Perin T, Roncella M, Roncalli MG, Rulli A, Sidoni A, Tinterri C, Truglia MC, Sperduti I. Elaboration of a nomogram to predict nonsentinel node status in breast cancer patients with positive sentinel node, intraoperatively assessed with one step nucleic amplification: Retrospective and validation phase. J Exp Clin Cancer Res 2016; 35:193. [PMID: 27931238 PMCID: PMC5146809 DOI: 10.1186/s13046-016-0460-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/19/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Tumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND). METHODS The following parameters were recorded: Clinical: hospital, age, medical record number; Bio pathological: Tumor (T) size stratified in quartiles, grading (G), histologic type, lymphatic/vascular invasion (LVI), ER-PR status, Ki 67, molecular classification (Luminal A, Luminal B, HER-2 Like, Triple negative); Sentinel and non-sentinel node related: Number of NSNs removed, number of positive NSNs, cytokeratin 19 (CK19) mRNA copy number of positive sentinel nodes stratified in quartiles. A total of 1945 patients were included in the database. All patient data were provided by the authors of this paper. RESULTS The discrimination of the model quantified with the area under the receiver operating characteristics (ROC) curve (AUC), was 0.65 and 0.71 in the validation and retrospective phase, respectively. The calibration determines the distance between predicted outcome and actual outcome. The mean difference between predicted/observed was 2.3 and 6.3% in the retrospective and in the validation phase, respectively. The two values are quite similar and as a result we can conclude that the nomogram effectiveness was validated. Moreover, the ROC curve identified in the risk category of 31% of positive NSNs, the best compromise between false negative and positive rates i.e. when ALND is unnecessary (<31%) or recommended (>31%). CONCLUSIONS The results of the study confirm that OSNA nomogram may help surgeons make an intraoperative decision on whether to perform ALND or not in case of positive sentinel nodes, and the patient to accept this decision based on a reliable estimation on the true percentage of NSN involvement. The use of this nomogram achieves two main gools: 1) the choice of the right treatment during the operation, 2) to avoid for the patient a second surgery procedure.
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Affiliation(s)
- Franco Di Filippo
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | | | | | | | | | | | | | | | | | - Simonetta Buglioni
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | | | - Rafael Cano
- Hospital Universitario de La Ribera, Alzira, Spain
| | | | | | | | | | | | | | | | - Roberto Franchini
- Azienda Ospedaliera “Maggiore della Carità” di Novara, Novara, Italy
| | | | - Diana Giannarelli
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | | | | | | | | | - Siobhan Laws
- Hampshire Hospitals NHS Foundation Trust, England, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Isabella Sperduti
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Almagro E, González CS, Espinosa E. [Prognostic factors of early breast cancer]. Med Clin (Barc) 2016; 146:167-71. [PMID: 25726309 DOI: 10.1016/j.medcli.2014.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 01/27/2023]
Abstract
Decision about the administration of adjuvant therapy for early breast cancer depends on the evaluation of prognostic factors. Lymph node status, tumor size and grade of differentiation are classical variables in this regard, and can be complemented by hormonal receptor status and HER2 expression. These factors can be combined into prognostic indexes to better estimate the risk of relapse or death. Other factors are less important. Gene profiles have emerged in recent years to identify low-risk patients who can forgo adjuvant chemotherapy. A number of profiles are available and can be used in selected cases. In the future, gene profiling will be used to select patients for treatment with new targeted therapies.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/genetics
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Clinical Decision-Making/methods
- Female
- Genetic Testing
- Humans
- Prognosis
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Affiliation(s)
- Elena Almagro
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Cynthia S González
- Servicio de Oncología Médica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Enrique Espinosa
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, España.
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Di Filippo F, Giannarelli D, Bouteille C, Bernet L, Cano R, Cunnick G, Sapino A. Elaboration of a nomogram to predict non sentinel node status in breast cancer patients with positive sentinel node, intra-operatively assessed with one step nucleic acid amplification method. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:136. [PMID: 26538019 PMCID: PMC4632276 DOI: 10.1186/s13046-015-0246-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/19/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUNDS Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted. METHODS The following parameters were recorded: CLINICAL hospital, age, medical record number Bio-pathological: tumor (T) size, grading (G), multifocality, histological type, LVI, ER-PR status, HER-2, ki67, molecular classification (luminal A, luminal B, HER2 like, triple negative) Sentinel and nonsentinel lymph node related: number of removed SLNs, number of positive and negative SLNs, copy number of positive sentinel nodes, ratio: number of positive SLNs to number of removed SLNs, number of removed and number of positive nodes after ALND. A total of 2460 patients have been included in the database. All the patients have been provided by the authors of this paper. RESULTS Multivariate logistic regression analysis demonstrated that only the number of a CK19 mRNA copies (p < 0.0001), T size (p < 0.0001) and LVI (p < 0.0001) were associated with NSN metastases. The discrimination of the model, quantified with the area under the receiver operating characteristics curve, was 0.71 (95 %, C.I. 0.69-0.73), thus confirming a good level of reliability. CONCLUSIONS The nomogram may be employed by the surgeon as a decision making tool on whether to perform an intraoperative axillary lymph node dissection on breast cancer patients with SLN positive. The large population employed and the standardized method of measuring the value of CK19 mRNA copies are appropiate prerequisites for a reliable nomogram.
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Affiliation(s)
- F Di Filippo
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00134, Rome, Italy.
| | - D Giannarelli
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00134, Rome, Italy.
| | | | - L Bernet
- Hospital de Xàtiva, Valencia, Spain.
| | - R Cano
- Hospital de Alzira, Valencia, Spain.
| | - G Cunnick
- Wycombe General Hospital, Buckinghamshire, England.
| | - A Sapino
- Istituto di Candiolo - IRCCS, Fpo-Ircc., Turin, Italy. .,Dept of Medical Sciences - University of Turin, Turin, Italy.
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