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Liu D, Chang L, Zhao X, Dai L, Cui H, Liu P, Zhai Z, Wu H, Ma X, Kang H. Effect of T Stages on the Choice of Axillary Evaluation Modality in Breast Cancer Patients With 1-2 Sentinel Lymph Node Metastases. Clin Breast Cancer 2024; 24:e232-e243.e1. [PMID: 38368246 DOI: 10.1016/j.clbc.2024.01.012] [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: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The survival benefit of axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB) combined with radiation, and ALND combined with radiation remains unclear in breast cancer (BC) patients with 1-2 metastatic sentinel lymph nodes (SLNs). This study aims to rigorously evaluate the prognostic impact of these axillary evaluation modalities on BC patients with varying T-stages and to construct a survival prediction nomogram. METHODS Following screening for inclusion and exclusion criteria, data pertaining to BC patients were extracted from the SEER database. Overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Kaplan-Meier curves and Cox proportional hazards model among patients with different stages who underwent various axillary evaluation modalities. A nomogram was constructed to predict the probability of OS and BCSS. RESULTS A total of 20,283 patients were included, comprising 9626 who underwent breast-conserving surgery (BCS) and 10,657 who underwent mastectomy. In the T4 stage stratified analysis, both BCS and mastectomy groups exhibited superior OS and BCSS with ALND compared to SLNB combined with radiation. Further, ALND combined with radiation improved OS. However, for T1-3 stages, patients treated with ALND experienced similar or worse survival compared to those treated with SLNB combined with radiation. The calibration curve and C-index (0.746-0.794) of the nomogram demonstrated the efficacy of the survival prediction model. CONCLUSION In T1-3 BC patients with 1-2 metastatic SLNs, SLNB combined with radiation is a safe alternative to ALND. Conversely, for T4 patients, ALND combined with radiation may offer a preferable choice.
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Affiliation(s)
- Dandan Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Lidan Chang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Xuyan Zhao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Luyao Dai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Hanxiao Cui
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Peinan Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Zhen Zhai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Hao Wu
- Department of Biophysics, School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University Health Science Center, No.76 Western Yanta Road, Xi'an, Shaanxi, 710061, China.
| | - Xiaobin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China.
| | - Huafeng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China.
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Lu X, He M, Yu L, Gou Z. Is repeat sentinel lymph node biopsy possible for surgical axillary staging among patients with ipsilateral breast tumor recurrence? Cancer 2023; 129:1492-1501. [PMID: 36807239 DOI: 10.1002/cncr.34708] [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: 10/06/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND There is a lack of studies assessing the survival of repeat sentinel lymph node biopsy (rSLNB) versus axillary lymph node dissection (ALND) for surgical axillary staging among patients with ipsilateral breast tumor recurrence (IBTR). METHODS We retrospectively identified patients with IBTR from the Surveillance, Epidemiology, and End Results database from 2000 to 2017. The primary outcome was overall survival (OS) between the rSLNB and ALND groups. RESULTS Of the 2141 women with IBTR after lumpectomy and SLNB, 524 did not receive surgical axillary staging (nonsurgery group) and 1617 patients who did undergo axilla surgery received either rSLNB or ALND as axillary staging (1268 with rSLNB and 349 with ALND). The 10-year OS rates were 61.9% for the nonsurgery and 73.8% for axilla surgery groups (p = .001). In the 1:1 matched cohorts, the 10-year OS rates were 61.4% for the nonsurgery and 69.1% for axilla surgery groups (p = .072). After adjusting for other factors, axillary surgery treatment of IBTR was an independent favorable factor for OS (hazard ratio [HR], 0.71; 95% CI, 0.56-0.90; p = .004). Within the axilla surgery group, rSLNB presented a comparable 10-year OS to the ALND cohort (log-rank test p = .054). Multivariate Cox analysis, as well as subgroup analysis, showed that rSLNB had a similar benefit to ALND (10-year OS; HR, 1.18; 95% CI, 0.88-1.58; p = .268). CONCLUSIONS The results of this cohort study suggested that receiving surgical axillary staging was associated with better survival of IBTR patients, and rSLNB had a similar long-term survival outcome as ALND. rSLNB might be considered for surgical axillary staging among patients with IBTR after lumpectomy and initial SLNB.
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Affiliation(s)
- Xunxi Lu
- Department of Pathology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengting He
- Department of Breast Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Luoting Yu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Zongchao Gou
- Department of Breast Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
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Dixon JM, Grewar J, Twelves D, Graham A, Martinez-Perez C, Turnbull A. Factors affecting the number of sentinel lymph nodes removed in patients having surgery for breast cancer. Breast Cancer Res Treat 2020; 184:335-343. [PMID: 32809181 PMCID: PMC7599142 DOI: 10.1007/s10549-020-05843-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022]
Abstract
Purpose The goal of sentinel lymph node biopsy is to establish the presence or absence of cancer cells in regional axillary nodes. The number of sentinel nodes harvested from each patient varies. The aim of this study was to determine what factors influence the number of sentinel nodes excised at sentinel node biopsy. Methods Data from 426 patients with breast cancer who underwent sentinel lymph node biopsy at the Edinburgh Breast Unit by 10 different experienced breast surgeons were included in this analysis. Univariate and multivariable statistical analysis was performed. Results In the multivariate analysis the number of sentinel nodes biopsied varied significantly between operating surgeon (p < 0.0001) and was also statistically associated with the use of neoadjuvant chemotherapy (p < 0.0001) and with the number of involved lymph nodes (p < 0.0001). More nodes were removed in patients who received neoadjuvant chemotherapy and had metastases in sentinel lymph nodes. Conclusions This study shows that the surgeon plays a pivotal and significant role in determining the numbers of sentinel nodes removed by sentinel lymph node biopsy. Surgeons should monitor their own data on the average numbers of sentinel nodes they remove. Some surgeons may not be removing sufficient numbers of sentinel nodes to maintain a low false negative rate for this procedure. Electronic supplementary material The online version of this article (10.1007/s10549-020-05843-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit and Breast Cancer Now Group, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. .,Edinburgh Breast Unit, NHS Lothian, Edinburgh, UK.
| | - Julia Grewar
- Medical School, University of Edinburgh, Edinburgh, UK
| | | | | | - Carlos Martinez-Perez
- Edinburgh Breast Unit and Breast Cancer Now Group, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Arran Turnbull
- Edinburgh Breast Unit and Breast Cancer Now Group, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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de Meric de Bellefon M, Lemanski C, Ducteil A, Fenoglietto P, Azria D, Bourgier C. Management of the Axilla in the Era of Breast Cancer Heterogeneity. Front Oncol 2018; 8:84. [PMID: 29670853 PMCID: PMC5893721 DOI: 10.3389/fonc.2018.00084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/12/2018] [Indexed: 01/07/2023] Open
Abstract
Systemic cancer therapies take into account breast cancer (BC) heterogeneity by targeting pathways specifically involved in some BC subtypes. On the other hand, BC intrinsic radiosensitivity is poorly understood and studied. Hence, radiotherapy personalization in BC is still “work in progress”. In this review, we will summarize the existing data on the management of axillary lymph nodes in BC, the impact of BC radiotherapy on axillary management, the indications for axillary radiotherapy, and biomarkers to predict patients’ outcome (tumor control and late toxicities) after axillary irradiation.
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Affiliation(s)
| | - Claire Lemanski
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Angélique Ducteil
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | | | - David Azria
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Celine Bourgier
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France
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Hui L, Huang T, Lian J, Zhou F, Gao C, Lin Y, Tu H, Nan K, Li Z, Wei Y. Potential prognostic value of clinical characteristics, hormone status and major depressive disorder in breast cancer. Future Oncol 2017; 13:1493-1503. [PMID: 28589742 DOI: 10.2217/fon-2017-0515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIM To identify independent factors predicting overall survival (OS) of breast cancer (BC) patients. PATIENTS & METHODS Two hundred and eighty one women with BC were recruited and clinical characteristics including lymphovascular invasion, clinical stage of Tumor Node Metastasis and positive axillary lymph nodes were documented; immunohistochemistry/fluorescence in situ hybridization was used to examine the expression of estrogen receptor, progesterone receptor, HER2 and Ki-67; major depressive disorder was assessed with Diagnostic and Statistical Manual of Mental Disorders V. RESULTS Multivariable analyses indicated that in BC patients, lymphovascular invasion, Tumor Node Metastasis, pN, Ki-67 and major depressive disorder were significantly negatively correlated with OS; estrogen receptor was significantly positively associated with OS. CONCLUSION Early diagnostic approaches and effective psychologic intervention are indispensable for BC patients.
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Affiliation(s)
- Lingyun Hui
- Research Center of Medical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Tianhe Huang
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, PR China
| | - Jie Lian
- Department of Clinical Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Fuling Zhou
- Department of Clinical Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Chengge Gao
- Department of Psychology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yan Lin
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Honglei Tu
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Kejun Nan
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Zongfang Li
- National-local Joint Engineering Research Center of Biodiagnostics & Biotherapy, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yongchang Wei
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.,Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, PR China
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Marrazzo A, Damiano G, Taormina P, Buscemi S, Lo Monte AI, Marrazzo E. Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer. Clin Breast Cancer 2017; 17:e53-e57. [DOI: 10.1016/j.clbc.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/06/2016] [Accepted: 10/12/2016] [Indexed: 02/05/2023]
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