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Annals of Surgical Oncology

, Volume 15, Issue 2, pp 472–477 | Cite as

How Important is the Axillary Nodal Status for Adjuvant Treatment Decisions at a Breast Cancer Multidisciplinary Tumor Board? A Survival Analysis

  • Toralf Reimer
  • Rainer Fietkau
  • Susanne Markmann
  • Angrit Stachs
  • Bernd Gerber
Breast Oncology

Abstract

Background

Tumor board recommendations for breast cancer are mainly based on patient characteristics and prognostic tumor parameters. In the era of potential avoidance of axillary surgery we evaluate the impact of pathologic nodal status for adjuvant treatment decisions.

Methods

Postoperative tumor board records of 207 patients over a 1-year period were rediscussed without knowledge of pathologic nodal status. Differences were classified as major (chemotherapy and/or radiotherapy: present/absent) or minor (different chemotherapeutic protocols) discrepancies. The survival rates among subgroups were calculated using Adjuvant! Online tool.

Results

The tumor board without information of pathologic nodal status resulted in treatment changes in 72 of the 207 patients studied (34.8%). Major discrepancies were observed in 37 patients (17.9%). The survival rates were not significantly different due to a balanced overtreatment and undertreatment in this subgroup. Lymphovascular invasion (LVI) was an independent parameter used to predict the subgroup with major discrepancies (P = .001; RR = 4.9 [95% CI, 1.9–12.7]).

Conclusions

The knowledge of pathologic nodal status is important for postoperative chemotherapy and postmastectomy radiotherapy indications. There is a risk for one-third of all patients when avoiding axillary surgery to get an adjuvant therapy that differs from the current guidelines especially in carcinomas with present LVI.

Keywords

Axillary dissection Breast cancer Chemotherapy Radiotherapy Survival Tumor board 

References

  1. 1.
    Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 2002; 347:567–75PubMedCrossRefGoogle Scholar
  2. 2.
    Dees EC, Shulman LN, Souba WW, Smith BL. Does information from axillary dissection change treatment in clinically node-negative patients with breast cancer? Ann Surg 1997; 226:279–87PubMedCrossRefGoogle Scholar
  3. 3.
    Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol 1999; 6:109–16PubMedCrossRefGoogle Scholar
  4. 4.
    Parmigiani G, Berry DA, Winer EP, Tebaldi C, Iglehart JD, Prosnitz LR. Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis. J Clin Oncol 1999; 17:1465–73PubMedGoogle Scholar
  5. 5.
    Goldhirsch A, Coates AS, Gelber RD, Glick JH, Thürlimann B, Senn HJ. First—select the target: better choice of adjuvant treatments for breast cancer patients. Ann Oncol 2006; 17:1772–6PubMedCrossRefGoogle Scholar
  6. 6.
    Engel J, Lebeau A, Sauer H, Hölzel D. Are we wasting our time with the sentinel technique? Fifteen reasons to stop axilla dissection. Breast 2006; 15:452–5PubMedCrossRefGoogle Scholar
  7. 7.
    Henderson IC. Axillary surgery: clinical judgment required. J Clin Oncol 2006; 24:325–6PubMedCrossRefGoogle Scholar
  8. 8.
    Kuehn T, Bembenek A, Decker T, Munz DL, Sautter-Bihl ML, Untch M, Wallwiener D. A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance. Cancer 2005; 103:451–61PubMedCrossRefGoogle Scholar
  9. 9.
    Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thürlimann B, Senn HJ. Meeting highlights: International expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 2005; 16:1569–83PubMedCrossRefGoogle Scholar
  10. 10.
    Ravdin PM, Siminoff LA, Davis GJ, Mercer MB, Hewlett J, Gerson N, Parker HL. Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol 2001; 19:980–91PubMedGoogle Scholar
  11. 11.
    Chua B, Ung O, Taylor R, Boyages J. Is information from axillary dissection relevant to patients with clinically node-negative breast cancer? Breast J 2003; 9:478–84PubMedCrossRefGoogle Scholar
  12. 12.
    Greco M, Gennaro M, Valagussa P, et al. Impact of nodal status on indication for adjuvant treatment in clinically node negative breast cancer. Ann Oncol 2000; 11:1137–40PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson JSH, Olivotto IA, Wai E, Grau C, Mates D, Ragaz J. A decision analysis of the effect of avoiding axillary lymph node dissection in low risk women with invasive breast carcinoma. Cancer 2000; 88:1852–62PubMedCrossRefGoogle Scholar
  14. 14.
    Olivotto IA, Bajdik CD, Ravdin PM, et al. Population-based validation of the prognostic model ADJUVANT! for early breast cancer. J Clin Oncol 2005; 23:2716–25PubMedCrossRefGoogle Scholar
  15. 15.
    Wong JS, O’Neill A, Recht A, Schnitt SJ, Connolly JL, Silver B, Harris JR. The relationship between lymphatic vessel invasion, tumor size, and pathological nodal status: can we predict who can avoid a third field in the absence of axillary dissection? Int J Radiat Oncol Biol Phys 2000; 48:133–7PubMedCrossRefGoogle Scholar
  16. 16.
    Olivotto IA, Jackson JSH, Mates D, Andersen S, Davidson W, Bryce CJ, Ragaz J. Prediction of axillary lymph node involvement of women with invasive breast carcinoma. Cancer 1998; 83:948–55PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Toralf Reimer
    • 1
  • Rainer Fietkau
    • 2
  • Susanne Markmann
    • 3
  • Angrit Stachs
    • 1
  • Bernd Gerber
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity of RostockRostockGermany
  2. 2.Department of RadiotherapyUniversity of RostockRostockGermany
  3. 3.Department of Medical OncologyKlinikum SuedstadtRostockGermany

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