Predictors of non-sentinel lymph node metastasis in clinical early stage (cT1-2N0) breast cancer patients with 1-2 metastatic sentinel lymph nodes

Lale, Azmi; Yur, Mesut; Özgül, Halit; Alkurt, Ertuğrul Gazi; Yıldırım, Nilgün; Aygen, Erhan; Öz, Abdullah Bahadır; Arıkan, Tamer

doi:10.1016/j.asjsur.2019.07.019

Cited by 12 publications

(21 citation statements)

References 67 publications

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“…Previous studies have shown a clear association between LN size and metastasis. 14 , 25 In our study, LNM was confirmed in all the three cases with T2 GC and LNC on MDCT ≥ 1, two of which had more than 10 metastatic LNs. Therefore, radiologists should bear in mind that there may be extensive LNM in relatively early-stage GC patients with LNs greater than 8mm on MDCT.…”

Section: Discussionsupporting

confidence: 66%

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Gao¹,

Wang²,

Tang³

et al. 2022

CMAR

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Background The correlation between the preoperative lymph node count (LNC) on multidetector computed tomography (MDCT) and the prognosis of gastric carcinoma (GC) remains to be defined. This research aims to evaluate the prognostic value of LNC on MDCT in GC patients based on tumor-node-metastasis (TNM) staging, using different size criteria for counting. Methods The clinical data of 126 patients with gastric adenocarcinoma undergoing gastrectomy were retrospectively analyzed. Lymph nodes greater than 8mm and 5mm on MDCT were counted and recorded. The prognostic implications of LNC on MDCT for patient survival were analyzed according to different size criteria for counting and tumor TNM staging. Results When 8mm was used as the counting criterion, LNC on MDCT had no significant effect on the overall survival (OS) of the entire cohort. In addition, the OS of T1–T2 GC patients with LNC on MDCT ≥1 was significantly worse than that of patients with LNC on MDCT <1. When 5mm was used as the counting criterion, LNC on MDCT was found to be significantly associated with the OS of the entire cohort. In the subgroup analysis, patients with relatively advanced (T3-T4, N+ and III) GC with LNC on MDCT >7 showed a significantly worse OS than those with LNC on MDCT ≤7. LNC on MDCT >7 with 5mm as the counting criterion and Stage III were independent risk factors for adverse prognosis. Conclusion The prognostic value of LNC on MDCT based on different size criteria varies in patients with different stages of GC. LNC of a smaller size (5mm) on MDCT may be a prognostic factor for patients with relatively advanced GC.

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Section: Discussionsupporting

confidence: 66%

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Gao¹,

Wang²,

Tang³

et al. 2022

CMAR

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“…In contrast, the Helsinki University model ( 20 ) included a prediction variable of HER-2 status instead of PR status. Despite the fact that HER-2 positive is generally associated with NSLN positivity, the relationship between HER-2 status and NSLN positivity remains controversial ( 37 ), and the current study yielded no statistically significant differences.…”

Section: Discussioncontrasting

confidence: 62%

Application of the Machine-Learning Model to Improve Prediction of Non-Sentinel Lymph Node Metastasis Status Among Breast Cancer Patients

Deng

Zhang

2022

Front. Surg.

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BackgroundPerforming axillary lymph node dissection (ALND) is the current standard option after a positive sentinel lymph node (SLN). However, whether 1–2 metastatic SLNs require ALND is debatable. The probability of metastasis in non-sentinel lymph nodes (NSLNs) can be calculated using nomograms. In this study, we developed an individualized model using machine-learning (ML) methods to select potential variables, which influence NSLN metastasis.Materials and MethodsCohorts of patients with early breast cancer who underwent SLN biopsy and ALND between 2012 and 2021 were created (training cohort, N 157 and validation cohort, N 58) for the development of the nomogram. Three ML methods were trained in the training set to create a strong predictive model. Finally, the multiple iterations of the least absolute shrinkage and selection operator regression method were used to determine the variables associated with NSLN status.ResultsFour independent variables (positive SLN number, absence of lymph node hilum, lymphovascular invasion (LVI), and total number of SLNs harvested) were combined to generate the nomogram. The area under the receiver operating characteristic curve (AUC) value of 0.759 was obtained in the entire set. The AUC values for the training set and the test set were 0.782 and 0.705, respectively. The Hosmer-Lemeshow test of the model fit accuracy was identified with p = 0.759.ConclusionThis study developed a nomogram that incorporates ultrasound (US)-related variables using the ML method and serves to clinically predict the non-metastatic status of NSLN and help in the selection of the appropriate treatment option.

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“…In the earlier proposed nomograms, such as MSKCC, Tenon, and Cambridge, the location of the primary tumor was not included in the analysis, which may be caused by the incomplete clinicopathological information of the patient. With the development of the nomograms of NSLN prediction, the tumor location has been gradually included in the analysis and discussion but has not yet been considered as an independent predictor of NSLN metastasis ( 32 , 37 ). In our study, multivariate logistic regression analysis showed that the location of the primary tumor was an independent predictor of NSLN metastasis (OR = 4.678; 95% CI 2.784-7.862; p <0.001), indicating that the NSLN metastasis risk of the primary tumor in the upper outer quadrant was 4.678 times higher than the other quadrants of the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, early breast cancer patients with low axillary tumor burden, especially for T1–2 breast patients with only one SLN metastasis, theoretically have a lower axillary tumor burden and risk of NSLN metastasis. Previous studies have shown that the NSLN metastatic rate in breast cancer patients with only one SLN metastasis is approximately 25%–35% ( 30 , 31 ), while the NSLN metastatic rate in T1–2 breast cancer patients with SLN metastases is approximately 30%–40% ( 32 , 33 ). Therefore, as the most potential competitors for selective exemption of ALND, the predictors and prediction models of NSLN metastasis in T1–2 breast cancer patients with only one SLN metastasis need further research.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram for decision-making assistance on exemption of axillary lymph node dissection in T1–2 breast cancer with only one sentinel lymph node metastasis

Liu

Lin

et al. 2022

Front. Oncol.

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BackgroundT1–2 breast cancer patients with only one sentinel lymph node (SLN) metastasis have an extremely low non-SLN (NSLN) metastatic rate and are favorable for axillary lymph node dissection (ALND) exemption. This study aimed to construct a nomogram-based preoperative prediction model of NSLN metastasis for such patients, thereby assisting in preoperatively selecting proper surgical procedures.MethodsA total of 729 T1–2 breast cancer patients with only one SLN metastasis undergoing sentinel lymph node biopsy and ALND were retrospectively selected from Harbin Medical University Cancer Hospital between January 2013 and December 2020, followed by random assignment into training (n=467) and validation cohorts (n=262). A nomogram-based prediction model for NSLN metastasis risk was constructed by incorporating the independent predictors of NSLN metastasis identified from multivariate logistic regression analysis in the training cohort. The performance of the nomogram was evaluated by the calibration curve and the receiver operating characteristic (ROC) curve. Finally, decision curve analysis (DCA) was used to determine the clinical utility of the nomogram.ResultsOverall, 160 (21.9%) patients had NSLN metastases. Multivariate analysis in the training cohort revealed that the number of negative SLNs (OR: 0.98), location of primary tumor (OR: 2.34), tumor size (OR: 3.15), and lymph-vascular invasion (OR: 1.61) were independent predictors of NSLN metastasis. The incorporation of four independent predictors into a nomogram-based preoperative estimation of NSLN metastasis demonstrated a satisfactory discriminative capacity, with a C-index and area under the ROC curve of 0.740 and 0.689 in the training and validation cohorts, respectively. The calibration curve showed good agreement between actual and predicted NSLN metastasis risks. Finally, DCA revealed the clinical utility of the nomogram.ConclusionThe nomogram showed a satisfactory discriminative capacity of NSLN metastasis risk in T1–2 breast cancer patients with only one SLN metastasis, and it could be used to preoperatively estimate NSLN metastasis risk, thereby facilitating in precise clinical decision-making on the selective exemption of ALND in such patients.

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Predictors of non-sentinel lymph node metastasis in clinical early stage (cT1-2N0) breast cancer patients with 1-2 metastatic sentinel lymph nodes

Cited by 12 publications

References 67 publications

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Application of the Machine-Learning Model to Improve Prediction of Non-Sentinel Lymph Node Metastasis Status Among Breast Cancer Patients

A novel nomogram for decision-making assistance on exemption of axillary lymph node dissection in T1–2 breast cancer with only one sentinel lymph node metastasis

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