Multidisciplinary Management of the Axilla in Patients with cT1-T2 N0 Breast Cancer Undergoing Primary Mastectomy: Results from a Prospective Single-Institution Series

Grossmith, Samantha; Nguyen, Anvy; Hu, Jiani; Plichta, Jennifer K.; Nakhlis, Faina; Cutone, Linda; Dominici, Laura; Golshan, Mehra; Duggan, Margaret M.; Carter, Katharine; Rhei, Esther; Barbie, Thanh U.; Calvillo, Katherina Zabicki; Nimbkar, Suniti; Bellon, Jennifer R.; Wong, Julia S.; Punglia, Rinaa S.; Barry, William T.; King, Tari A.

doi:10.1245/s10434-018-6525-3

Cited by 16 publications

(11 citation statements)

References 49 publications

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“…Attempts to correlate TILs with lymph nodes status in triple negative tumors have failed [40]. Since the attitude versus BCT, and especially towards the axilla, changed significative in the last years after the published results of AMAROS clinical trial [41,42], the importance of identifying low and high risk-profile tumors has increased.…”

Section: Discussionmentioning

confidence: 99%

Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

Caziuc¹,

Schlanger²,

Amarinei³

et al. 2019

JCM

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The status of axillary lymph nodes is an important prognostic factor in the outcome of breast cancer tumors. New trials changed the attitude towards axillary clearance. In the era of development of new immune therapies for breast cancer, it is important to identify a biomarker that can predict lymph node status. Tumor-infiltrating lymphocytes (TILs) are a valuable indicator of the immune microenvironment that plays the central role in new anticancer drugs. Although the correlation between TILs and response to chemotherapy was established by previous studies, our retrospective study investigated the correlation between TILs and lymph node status. We analyzed data on 172 patients. According to stage, patients were divided in two groups: patients who underwent primary surgical treatment (breast-conserving or mastectomy and sentinel lymph node (SLN) biopsy +/− axillary clearance in conformity with lymph node status) and patients who received chemotherapy prior to surgical treatment (breast-conserving or mastectomy + axillary clearance). We showed a good inverse correlation between TILs and lymph nodes status for both early stage and locally advanced breast cancers. Moreover, TILs are a predictor for positive lymph nodes in the axilla in patients undergoing axillary clearance after SLN biopsy, with no statistical difference between the intrinsic or histological subtype of breast cancers. We also obtained a significant correlation between TILs and response to chemotherapy with no significative difference according to histological subtype. Although further data have still to be gathered before meeting the criteria for clinical utility, this study demonstrates that TILs are one of the most accredited forthcoming biomarkers for breast cancer (BC) patients.

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Section: Discussionmentioning

confidence: 99%

Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

Caziuc¹,

Schlanger²,

Amarinei³

et al. 2019

JCM

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“…Additionally, axillary lymph node dissection (ALND) is highly recommended for clinically node-positive breast cancer for its excellent regional control and better prognosis. A prospective single-institution study concluded that the number of positive nodes of ALND and tumor size were both associated with receipt of PMRT ( 25 ). Furthermore, several retrospective studies reported that T1–2 breast cancer with 1–3 positive axillary lymph nodes has a great heterogeneity, and the benefit from PMRT would vary significantly in this population ( 13 , 24 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

A Prognostic Risk Stratification Model to Identify Potential Population Benefiting From Postmastectomy Radiotherapy in T1–2 Breast Cancer With 1–3 Positive Axillary Lymph Nodes

et al. 2021

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Background and ObjectivesTo establish a prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive lymph nodes to determine which patients can benefit from postmastectomy radiotherapy (PMRT).MethodsA population-based study was conducted utilizing data collected from the Surveillance, Epidemiology, and End Results database. Chi-square test or Fisher exact test was used to compare the distribution of characteristics. Cox analysis identified significant prognostic factors for survival. A prognostic stratification model was constructed by R software. Propensity score matching was applied to balance characteristics between PMRT cohort and control cohort. Kaplan-Meier method was performed to evaluate the performance of stratification and the benefits of PMRT in the total population and three risk groups.ResultsThe overall performance of the nomogram was good (3-year, 5-year, 10-year AUC were 0.75, 0.72 and 0.67, respectively). The nomogram was performed to excellently distinguish low-risk, moderate-risk, and high-risk groups with 10-year overall survival (OS) of 86.9%, 73.7%, and 62.7%, respectively (P<0.001). In the high-risk group, PMRT can significantly better OS with 10-year all-cause mortality reduced by 6.7% (P = 0.027). However, there was no significant survival difference between PMRT cohort and control cohort in low-risk (P=0.49) and moderate-risk groups (P = 0.35).ConclusionThe current study developed the first prognostic stratification nomogram for T1–2 breast cancer with 1–3 positive axillary lymph nodes and found that patients in the high-risk group may be easier to benefit from PMRT.

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“…The results of this trial support omission of ALND in patients who will undergo axillary radiotherapy in this population. A multidisciplinary, institutional effort to implement the findings of the AMAROS trial has been described by Grossmith et al [29]. Intraoperative SLN evaluation was omitted for cT1-2 N0 patients undergoing upfront mastectomy who would potentially be eligible for PMRT including RNI.…”

Section: Discussionmentioning

confidence: 99%

Axillary management for young women with breast cancer varies between patients electing breast-conservation therapy or mastectomy

Tadros

Moo

Stempel

et al. 2020

Breast Cancer Res Treat

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Purpose-Axillary treatment strategies for the young woman with early-stage, clinically nodenegative breast cancer undergoing upfront surgery found to have 1-3 positive sentinel lymph nodes (SLNs) differ significantly after BCT and mastectomy. Here we compare axillary lymph node dissection (ALND) and regional nodal irradiation (NRI) rates between women electing breast-conservation therapy (BCT) versus mastectomy.Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1

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Multidisciplinary Management of the Axilla in Patients with cT1-T2 N0 Breast Cancer Undergoing Primary Mastectomy: Results from a Prospective Single-Institution Series

Abstract: For the majority of patients with one or two positive SLNs, ALND was avoided in favor of PMRT + AxRT. With appropriate multidisciplinary strategies, intraoperative evaluation of the SLN and immediate ALND can be avoided for patients meeting the AMAROS criteria and eligible for PMRT.

Cited by 16 publications

References 49 publications

Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

A Prognostic Risk Stratification Model to Identify Potential Population Benefiting From Postmastectomy Radiotherapy in T1–2 Breast Cancer With 1–3 Positive Axillary Lymph Nodes

Axillary management for young women with breast cancer varies between patients electing breast-conservation therapy or mastectomy

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