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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Rostock, Klinikum Suedstadt, Suedring 81, 18059, Rostock, Germany

    Toralf Reimer MD, Angrit Stachs MD & Bernd Gerber PhD

  2. Department of Radiotherapy, University of Rostock, Suedring 75, 18059, Rostock, Germany

    Rainer Fietkau PhD

  3. Department of Medical Oncology, Klinikum Suedstadt, Suedring 81, 18059, Rostock, Germany

    Susanne Markmann MD

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  1. Toralf Reimer MD
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  2. Rainer Fietkau PhD
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  3. Susanne Markmann MD
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  4. Angrit Stachs MD
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  5. Bernd Gerber PhD
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Correspondence to Toralf Reimer MD.

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Reimer, T., Fietkau, R., Markmann, S. et al. How Important is the Axillary Nodal Status for Adjuvant Treatment Decisions at a Breast Cancer Multidisciplinary Tumor Board? A Survival Analysis. Ann Surg Oncol 15, 472–477 (2008). https://doi.org/10.1245/s10434-007-9670-7

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  • DOI: https://doi.org/10.1245/s10434-007-9670-7

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