IntroductionIncreased abdominal visceral adipose tissue (VAT) implies an adverse cardio-metabolic profile. We examined the association of abdominal VAT parameters and all-cause mortality risk.MethodsWe systematically searched four databases. We performed citations/articles screening, data abstraction, and quality assessment in duplicate and independently (CRD42020205021).ResultsWe included 12 cohorts, the majority used computed tomography to assess abdominal VAT area. Six cohorts with a mean age ≤ 65 years, examining all-cause mortality risk per increment in VAT area (cm2) or volume (cm3), showed a 11-98% relative risk increase with higher VAT parameters. However, the association lost significance after adjusting for glycemic indices, body mass index, or other fat parameters. In 4 cohorts with a mean age >65 years, the findings on mortality were inconsistent. Conversely, in two cohorts (mean age 73-77 years), a higher VAT density, was inversely proportional to VAT area, and implied a higher mortality risk.ConclusionA high abdominal VAT area seems to be associated with increased all-cause mortality in individuals ≤ 65 years, possibly mediated by metabolic complications, and not through an independent effect. This relationship is weaker and may reverse in older individuals, most likely secondary to confounding bias and reverse causality. An individual participant data meta-analysis is needed to confirm our findings, and to define an abdominal VAT area cutoff implying increased mortality risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205021, identifier CRD42020205021.
Background There is an increase in the use of neoadjuvant chemotherapy (NACT) to downstage breast cancer. Sentinel lymph node biopsy (SLNB) has replaced Axillary lymph node dissection (ALND) as a standard of care for the treatment of breast cancer patients with negative axilla at presentation. However, the reliability of SLNB after NACT in patients with initially node-positive breast cancer is still controversial and debatable. This meta-analysis was conducted to investigate the accuracy and feasibility of SLNB after NACT in patients presented with positive axillary lymph nodes. Methods A comprehensive literature search was conducted using Medline, PubMed, Embase, Central, and SCOPUS for studies from their date of inception till April 2021 on the performance of SLNB following NACT in clinically node-positive breast cancer patients. We included prospective studies including breast cancer patients with positive lymph nodes at diagnosis, receiving neoadjuvant chemotherapy before undergoing an SLNB, irrespective of their molecular subtypes or breast cancer stage. We excluded retrospective studies, case reports, review articles, and letter to editors. The main outcomes of interest were the false negative rate (FNR) and the identification rate (IR). We also aimed to investigate the accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity, and sensitivity of the SLNB procedure. Results An aggregate of 33 studies were included in this meta-analysis enrolling 4624 patients. The pooled identification rate (IR) was 88% (95% CI: 86-90; heterogeneity I2: 80.93 %) and the false negative rate (FNR) was 13% (95% CI: 11-15; heterogeneity I2: 72.31%). The pooled accuracy, NPV, PPV, specificity and sensitivity were 91.8% (95% CI: 69.39 -114.3), 82.8% (95%CI: 60.19-105.52), 98.2% (95%CI: 65.86 -130.63), 93.7% (95 CI%: 32.4 -155.03), 82.1% (95%CI: 58.38- 107.24) respectively. Conclusion In this comprehensive meta-analysis, we were able to review the largest number of studies (N=33) and patients (N=4624). We carried out this study with the intention to overcome the limitations of previously conducted meta-analyses such as including retrospective studies and a mixed population of clinically node-positive and node-negative breast cancer patients. Based on current findings, the usage of SLNB instead of ALND for the treatment of node-positive breast cancer patients is acceptable. However, further analysis is needed for the improvement of SLNB performance. Keywords: Sentinel lymph node biopsy; Breast cancer; Node positive; Neoadjuvant chemotherapy. Citation Format: Mariam Zahwe, Abir Ghzaiel, Malak Ghezzawi, Sarah El Iskandarani, Marwa Diab, Lara Soueid, Miryam El Jibbawi, Ahmad Najia, Khalil El Asmar, Eman Sbaity. Performance of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Clinically Node Positive Breast Cancer Patients: Systematic Review and Meta-analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-25.
Purpose The ACOSOG-Z0011 clinical trial introduced drastic changes to the traditional surgical practice for early breast cancer with positive sentinel lymph nodes. This study evaluates how these changes have affected the surgical management of early breast cancer at our institution. Methods A retrospective chart review was conducted for Lebanese women with a diagnosis of invasive breast cancer and who were ≥18 years of age, had undergone upfront breast-conserving surgery, and SLNB without any prior chemotherapy had no distant metastasis and had one or more positive SLNs, between 2011 and 2016. Results Data from our cohort shows that 78% of patients out of the 233 with clinically negative nodes go on to have negative nodes on surgical sentinel pathology as well. However, the incidence of micromets is 5.5% amongst positive SLNs versus 94% of positive SLNs having macromets. Survival data analysis showed a 5-year and 10-year locoregional recurrence rates of 1.72% and 2.15%, respectively. At 3-years follow-up, distant metastasis occurred in 3.4% of cases. Additionally, the 10-year overall survival is 98.7% and disease-free survival is 95.3%. The rates of ALND decreased from 46.7% to 18.2% in patients with 2 or less positive sentinel nodes between the two time periods 2011-2013 and 2014-2016. Conclusion With a follow-up period extending more than five years, our study shows that ALND offers no superiority to SLNB alone in terms of overall survival and disease-free survival. This does not only conform with the findings of Z0011 but adds to its generalizability to populations of different ethnicities.
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