Omission of Axillary Dissection According to ACOSOG Z0011: Impact on Adjuvant Treatment Recommendations

Aigner, Julia; Smetanay, Katharina; Hof, Holger; Sinn, Hans‐Peter; Sohn, Christof; Schneeweiß, Andreas; Marmé, Frederik

doi:10.1245/s10434-012-2798-0

Cited by 25 publications

(12 citation statements)

References 28 publications

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“…By omitting to perform this complementary resection, 10–18% of patients with SN involved by ITC or micrometastases have non-sentinel node macrometastases that remain unknown. This should lead clinicians to make the choice to use systemic chemotherapy for TNBC patients presenting ITC or micrometastases as the only poor prognostic feature (Aigner et al , 2013). …”

Section: Discussionmentioning

confidence: 99%

Axillary lymph node micrometastases decrease triple-negative early breast cancer survival

et al. 2016

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Background:Triple-negative breast cancers (TNBCs) are the most deadly form of breast cancer (BC) subtypes. Axillary lymph node involvement (ALNI) has been described to be prognostic in BC taken as a whole, but its prognostic value in each subtype is unclear. We explored the prognostic impact of ALNI and especially of small size axillary metastases in early TNBCs.Methods:We analysed in this multicentre study all patients treated for early TNBC in 12 French cancer centres. We explored the correlation between clinicopathological data and ALNI, with a specific focus on the dichotomisation between macrometastases and occult metastases, which is defined as the presence of isolated tumour cells or micrometastases. The prognostic value of ALNI both in terms of disease-free survival (DFS) and overall survival (OS) was also explored.Results:We included 1237 TNBC patients. Five-year DFS and OS were 83.7% and 88.5%, respectively. The identified independent prognostic features for DFS were tumour size >20 mm (hazard ratio (HR)=1.86; 95% CI: 1.11–3.10, P=0.018), lymphovascular invasion (HR=1.69; 95% CI: 1.21–2.34, P=0.002) and ALNI both in case of macrometastases (HR=1.97; 95% CI: 1.38–2.81, P<0.0001) and occult metastases (HR=1.72; 95% CI: 1.1–2.71, P=0.019). DFS and OS were similar between tumours with occult metastases and macrometastases. Tumours presenting at least two pejorative features (out of ALNI, lymphovascular invasion and large tumour size) displayed a significantly poorer DFS in both the training set and validation set, independently of chemotherapy administration. Tumours with no more than one of the above-cited pejorative features had a 5-year OS of ⩾90% vs 70% for other cases (P<0.0001).Conclusions:Axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumour cells were identified in lymph nodes. This impact is independent of chemotherapy use.

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Section: Discussionmentioning

confidence: 99%

Axillary lymph node micrometastases decrease triple-negative early breast cancer survival

et al. 2016

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“…During the past five years since the publication of Z0011, the study has been described as a practice-changing trial 19 . Some centers in the United States, Europe and Australia have applied Z0011 criteria to their own population and found the criteria is eligible 10 20 21 22 . However, in China ALND is still recommended for patients with positive SLNs according to the guideline of Breast Cancer Committee affiliated with Chinese Anti-Cancer Association 23 .…”

Section: Discussionmentioning

confidence: 99%

The feasibility of the ACOSOG Z0011 Criteria to Chinese Breast Cancer Patients: A Multicenter Study

Miao

Wang

Cui

et al. 2015

Sci Rep

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The aim of this study was to determine the feasibility of the Z0011 criteria to Chinese breast cancer patients. An survey about the Z0011 trial was distributed and we collected 658 consecutive patients with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy from five centers’ databases and grouped them as eligible or ineligible for omitting ALND according to the Z0011 criteria. The eligible group was compared with the cohort included in the Z0011 trial and with the ineligible group. Of the 427 respondants, 106 (24.8%) and 130 (30.4%)would not routinely perform ALND in patients meeting Z0011 criteria before and after learning of the trial results, respectively. Among the 658 patients, 151 (22.9%) were eligible and 507 were ineligible for omitting ALND. The clinicopathologic factors were not statistically different between the eligible group and the Z0011 cohort. Compared with the eligible Group, the ineligible group had significantly more T2 and T3 stage tumors, positive lymph nodes(LNs) and positive non-sentinel lymph nodes (NSLNs) (P < 0.01). The findings suggest good exportability of the Z0011 criteria to Chinese patients omitting ALND, but application of Z0011 as national treatment guideline still needs additional time and effort.

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“…However, in the study by Aigner et al 27 , indication of AC was modified in 18.2% of cases. In the Multicenter Clinical Trial AATRM 4 , 247 patients with Mic were randomized between cALND and no cALND and AC rate was higher in those who underwent cALND (40.2%) compared to those without cALND (36.8%).…”

Section: Resultsmentioning

confidence: 92%

Is sentinel lymph node biopsy alone accurate for breast cancer mastectomy? Results of a cohort study of 2423 patients.

Houvenaeghel¹,

Classe²,

Blache³

et al. 2019

Preprint

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Backgroud : Few patients with mastectomy and only with pN0(i+) or pN1mi sentinel node (SN) were included in randomized trial. To demonstrate SN biopsy accuracy for mastectomy. Methods: We examined results of SN among a multi-institutional cohort of patients, <=cT2-N0, who required total mastectomy, according to SN status and complementary axillary lymph-node dissection (cALND) or not. We have analyzed involved non-sentinel node (NSN) rate at cALND, overall (OS) and disease-free survival (DFS). Results: Among 2423 patients we reported 1307 pN0(i-)SN, 120 pN0(i+)SN, 273 pN1miSN and 723 pN1macro-metastases SN with cALND respectively in 24.5, 73.3, 82.4 and 93.1%. Median follow-up was 42.72 months. Among 320 patients with pN0(i-)SN we observed 35 NSN macro-metastases (10.9%) and among 723 patients with SN macro-metastases, cALND was omitted in 50 patients (6.9%): in multivariate analysis, OS and DFS were not significantly different according to cALND or not. Among 120 patients with pN0(i+)SN and 273 with pN1miSN, cALND were respectively omitted in 32 and 48 patients: age, pT-size and SN-status were predictive of NSN involvement. In multivariate analysis, post-mastectomy radiotherapy, regional nodal irradiation and adjuvant chemotherapy were significantly correlated to cALND and a significant lesser DFS rate was reported for patients without cALND (HR: 3.861, p=0.002). Conclusion: SN biopsy appeared as an accurate procedure for axillary staging of breast cancer mastectomy for pN0 SN status. For pN1-macro-metastases it is not possible to propose to avoid cALND. When SN was involved by ITC or micro-metastases, omission of cALND is still controversial and should have a negative prognosis impact in relation with a down staging and under treatment.

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Omission of Axillary Dissection According to ACOSOG Z0011: Impact on Adjuvant Treatment Recommendations

Abstract: Completion ALND for patients with one or two metastatic sentinel nodes in pT1-2 cN0 PBC treated with BCT does have a relevant impact on adjuvant treatment. This should be considered in shared decision making.

Cited by 25 publications

References 28 publications

Axillary lymph node micrometastases decrease triple-negative early breast cancer survival

Axillary lymph node micrometastases decrease triple-negative early breast cancer survival

The feasibility of the ACOSOG Z0011 Criteria to Chinese Breast Cancer Patients: A Multicenter Study

Is sentinel lymph node biopsy alone accurate for breast cancer mastectomy? Results of a cohort study of 2423 patients.

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