The Extent of Axillary Surgery Is Associated With Breast Cancer-specific Survival in T1–2 Breast Cancer Patients With 1 or 2 Positive Lymph Nodes

Li, Shunrong; Liu, Fengtao; Chen, Kai; Rao, Nanyan; Xie, Yufen; Su, Fengxi; Zhu, Liling

doi:10.1097/md.0000000000003254

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…By considering the other emerging factors 42,43 that influence survival after ALND in breast carcinoma, such studies should investigate specific subgroups, not the entire population of patients.…”

Section: Resultsmentioning

confidence: 99%

“…41 A large review conducted on patients with 1 to 2 metastatic lymph nodes who underwent SLNB or ALND showed an increase of breast cancerespecific survival limited to patients younger than 50 years old with hormone receptorenegative tumors who underwent ALND. 42 It seems that only some subgroups of patients draw benefit from ALND, not the entire population.…”

Section: Author's Personal Copymentioning

confidence: 99%

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Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Author's Personal Copymentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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“…A recent report based on data from the Surveillance, Epidemiology, and End Results population study did not find any difference in breast cancer-specific survival in patients who underwent ALND or SLNB after adjustment for tumor stage, HRs status, and tumor grade ( 11 ). The study inclusion criteria were patients with T1-2 invasive BC and 1–2 positive lymph nodes (N1 only, patients with N0i+ and N1mi were not included).…”

Section: Resultsmentioning

confidence: 98%

Management of the Axilla in the Era of Breast Cancer Heterogeneity

et al. 2018

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Systemic cancer therapies take into account breast cancer (BC) heterogeneity by targeting pathways specifically involved in some BC subtypes. On the other hand, BC intrinsic radiosensitivity is poorly understood and studied. Hence, radiotherapy personalization in BC is still “work in progress”. In this review, we will summarize the existing data on the management of axillary lymph nodes in BC, the impact of BC radiotherapy on axillary management, the indications for axillary radiotherapy, and biomarkers to predict patients’ outcome (tumor control and late toxicities) after axillary irradiation.

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“…In a large report based on SEER data [11], there was a significantly better survival for patients who had 3 nodes removed compared to patients with 1 or 2 involved nodes: Hazard Ratio of 0.73 CI 95% [0.60-0.88], p < 0.001. This improvement in survival was largely driven by the poorer outlook in the group who had only one SLN removed.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the number of sentinel lymph nodes removed in patients having surgery for breast cancer

Dixon

Grewar

Twelves

et al. 2020

Breast Cancer Res Treat

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Purpose The goal of sentinel lymph node biopsy is to establish the presence or absence of cancer cells in regional axillary nodes. The number of sentinel nodes harvested from each patient varies. The aim of this study was to determine what factors influence the number of sentinel nodes excised at sentinel node biopsy. Methods Data from 426 patients with breast cancer who underwent sentinel lymph node biopsy at the Edinburgh Breast Unit by 10 different experienced breast surgeons were included in this analysis. Univariate and multivariable statistical analysis was performed. Results In the multivariate analysis the number of sentinel nodes biopsied varied significantly between operating surgeon (p < 0.0001) and was also statistically associated with the use of neoadjuvant chemotherapy (p < 0.0001) and with the number of involved lymph nodes (p < 0.0001). More nodes were removed in patients who received neoadjuvant chemotherapy and had metastases in sentinel lymph nodes. Conclusions This study shows that the surgeon plays a pivotal and significant role in determining the numbers of sentinel nodes removed by sentinel lymph node biopsy. Surgeons should monitor their own data on the average numbers of sentinel nodes they remove. Some surgeons may not be removing sufficient numbers of sentinel nodes to maintain a low false negative rate for this procedure.

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The Extent of Axillary Surgery Is Associated With Breast Cancer-specific Survival in T1–2 Breast Cancer Patients With 1 or 2 Positive Lymph Nodes

Abstract: Supplemental Digital Content is available in the text

Cited by 7 publications

References 12 publications

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Management of the Axilla in the Era of Breast Cancer Heterogeneity

Factors affecting the number of sentinel lymph nodes removed in patients having surgery for breast cancer

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