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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3305–3311 | Cite as

Patterns in the Use of Axillary Operations for Patients with Node-Positive Breast Cancer After Neoadjuvant Chemotherapy: A National Cancer Database (NCDB) Analysis

  • Marissa K. Srour
  • Joshua Tseng
  • Michael Luu
  • Rodrigo F. Alban
  • Armando E. Giuliano
  • Alice ChungEmail author
Breast Oncology

Abstract

Background

The American College of Surgeons Oncology Group (ACOSOG) Z1071 and Sentinel Neoadjuvant (SENTINA) trials of sentinel node biopsy for node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) demonstrated false-negative rates that varied on the basis of surgical technique. This study evaluated trends in axillary operations before and after publication of these trials.

Methods

This study analyzed patients from National Cancer Database (NCDB) with clinical T0 through T4, N1 and N2, M0 breast cancer who received NAC from 1 January 2012 to 31 December 2015 and sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND). The patients were divided into the following groups: SNB, ALND, and (SNB + ALND).

Results

Of the 32,036 evaluable patients identified in this study. 5565 had SNB, 19,930 had ALND, and 6541 had SNB + ALND. Compared with the ALND group, the SNB group was younger, had more invasive ductal cancers, and had lower clinical T- and N-stage disease (p < 0.001). The patients in the SNB group had a higher rate of estrogen receptor-positive and triple-negative breast cancers, but a lower rate of human epidermal growth factor receptor 2 (HER2)-positive cancer (p < 0.001). The nodal pathologic complete response (PCR) rate, defined as no residual invasive cancer, was 66.5% in the SNB group and 33.1% in the ALND group. Since 2013, the rate of ALND has decreased from 88.7 to 77.1% in both community and academic institutions (p < 0.001).

Conclusion

Since publication of the ACOSOG Z1071 and SENTINA trials, the national rates of ALND in node positive breast cancer treated with NAC have decreased despite reported false-negative SNB rates and lack of prospective outcome data regarding the oncologic safety of ALND omission.

Notes

Acknowledgment

The authors thank the Fashion Footwear Charitable Foundation of New York, Inc.; The Margie and Robert E. Petersen Foundation Associates for Breast and Prostate Cancer Studies; and Linda and Jim Lippman for their contributions to this study.

Disclosure

There are no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Marissa K. Srour
    • 1
  • Joshua Tseng
    • 1
  • Michael Luu
    • 2
  • Rodrigo F. Alban
    • 1
  • Armando E. Giuliano
    • 1
  • Alice Chung
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of Biostatistics and BioinformaticsCedars-Sinai Medical CenterLos AngelesUSA

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