Axillary surgery for breast cancer: past, present, and future

Noguchi, Masakuni; Inokuchi, Masafumi; Noguchi, Miki; Morioka, Emi; Ohno, Yukako; Kurita, Tomoyuki

doi:10.1007/s12282-020-01120-0

Cited by 33 publications

(22 citation statements)

References 31 publications

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“…Despite newer therapies in the recent years, recurrence and metastasis remain the main challenges of cancer management. In China, as a result of late diagnosis, about 30-40% of invasive breast cancer patients will eventually develop into metastatic breast cancer, and patients have a low 5-year survival rate of less than 30% (Early Breast Cancer Trialists' Collaborative Group et al, 2012;Noguchi et al, 2020). Although there were recent improvements in early detection and progress in surgical techniques and multimodal therapy, and the clinical outcomes and quality of life have improved, breast cancer remains the leading cause of cancer death for women (Waks and Winer,…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

Chen

Bai

Kong

et al. 2021

Front. Cell Dev. Biol.

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ObjectivePrognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT).MethodsA total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC).ResultsThe results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression.ConclusionPretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

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Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

Chen

Bai

Kong

et al. 2021

Front. Cell Dev. Biol.

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“…Most of the ARM nodes (96.3%) were identified in field A (above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle), which proves there is a preferred anatomical lymph path for the drainage of the arm. Ikeda et al also identified the most ARM nodes in field A, while Han et al identified 58.76% of ARM nodes inferior to the axillary vein and lateral to the thoracodorsal bundle (field A, according to the Ikeda et al classification) [ 2 , 19 ]. We analyzed the relationship between the anatomical localization and metastatic involvement of ARM lymph nodes, but we found no statistically significant relationship; since this is the first time this relationship is discussed, further analysis might be useful to be repeated on larger groups of patients.…”

Section: Discussionmentioning

confidence: 99%

“…When ALND is combined with radiation therapy (RT), lymphedema rates are higher than with ALND alone (30%–50%) [ 1 ]. Although the use of sentinel node biopsy (SNB) has been shown to reduce the risk of lymphedema, recent studies cited an incidence of 4%–7%, which is still clinically significant [ 1 , 2 ]. Measures to reduce damage to the lymphatic drainage to the arm are therefore highly desirable.…”

Section: Introductionmentioning

confidence: 99%

Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique

Caziuc

Schlanger

Amarinei

et al. 2021

JCM

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Introduction. Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. Material and methods. In total, 30 breast cancer patients scheduled for axillary lymph node dissection were enrolled in our study. The lymphatic nodes that drain the arm were identified by injecting 1 mL of blue dye in the ipsilateral upper arm; then, the ARM nodes were resected along with the other lymph nodes and sent for histological evaluation. Results. Identification of ARM node was successful in 18 patients (60%) and 22.22% of the identified ARM lymph nodes had metastatic involvement. Patients with identified ARM nodes had a significant lower BMI and a statistically significant relationship between axillary lymph node status and ARM node metastases was proven. Most of ARM lymph nodes (96.3%) were found above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle. Conclusions. The ARM procedure is easy to reproduce but might not be appropriate for patients with a high BMI. The rate of metastatic involvement of ARM nodes is significant and no factor can predict it, showing that the preservation of these nodes cannot be considered.

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“…The frequency of systematic lymphadenectomy has been reduced. Patients with clinically negative lymph nodes did not have different recurrence-free or overall survival intervals during a 25-year follow-up, regardless of whether a systematic lymphadenectomy was performed [4]. In fact, a systematic axillary lymph node dissection was not needed in speci c patients with positive lymph nodes.…”

Section: Introductionmentioning

confidence: 91%

“…In fact, a systematic axillary lymph node dissection was not needed in speci c patients with positive lymph nodes. [5] Thus, adverse outcomes directly caused by lymph node dissection, such as lymphedema, were reduced from 15.3 % after axillary lymph node dissection to 3.3 % after sentinel node biopsy [4]. Ongoing research has been focused on reducing the extent of treatment in endometrial cancer, despite clear differences between the lymphatic drainage of the uterus and that of the mammary glands [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of Lymphadenectomy on Short- and Long-term Complications in Patients With Endometrial Cancer

Proppe

Alkatout

Koch

et al. 2021

Preprint

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IntroductionEarly endometrial cancer is primarily treated surgically via hysterectomy, adenectomy and, depending on tumor stage and subtype, lymphadenectomy. Systematic lymph node dissection is known to cause surgical complications. The aim of the present study was to investigate morbidity and mortality rates associated with lymphadenectomy in patients with endometrial cancer who underwent surgery in a routine clinical setting.MethodsWe collected data from 232 patients who were operated for endometrial carcinoma between 2006 and 2018 at the University of Luebeck, Germany. Surgical complications were viewed in relation to surgical risk factors. Additionally, a questionnaire concerning long-term lymphatic complications and survival was completed. Survival was compared between patients who underwent lymphadenectomy (group I) and those who did not (group II). Results Patients in group I needed revision surgery significantly more often due to postoperative complications (such as lymphoceles) compared to those in group II (p = 0.01). The results indicate more serious complications in patients who underwent a systematic lymphadenectomy and in those with lymph node metastases.15 % of patients who underwent a systematic lymphadenectomy had lymph node metastases. Recurrences occurred in 12.5 % of cases and were significantly more frequent in patients who had undergone a lymphadenectomy, even if the lymph nodes were negative (p = 0.02). A comparison of survival data during the follow-up period revealed no significant difference.The study highlighted the need for a better preoperative risk stratification and the avoidance of lymphadenectomy for surgical staging alone.

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Axillary surgery for breast cancer: past, present, and future

Cited by 33 publications

References 31 publications

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique

Impact of Lymphadenectomy on Short- and Long-term Complications in Patients With Endometrial Cancer

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