Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3559–3566 | Cite as

Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011

  • Cecilia T. Ong
  • Samantha M. Thomas
  • Rachel C. Blitzblau
  • Oluwadamilola M. Fayanju
  • Tristen S. Park
  • Jennifer K. Plichta
  • Laura H. Rosenberger
  • Terry Hyslop
  • E. Shelley Hwang
  • Rachel A. Greenup
Breast Oncology
  • 275 Downloads

Abstract

Background

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of axillary surgery among women eligible for Z0011 based on patient age and tumor subtype.

Methods

Patients with cT1–2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1–5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND.

Results

The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes.

Conclusions

Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of axillary surgery differed by patient age and tumor subtype.

Notes

Disclosure

There are no conflicts of interest.

References

  1. 1.
    Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8 (Discussion 398401).CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Krag DN, Anderson SJ, Julian TB, et al. Sentinel lymph node resection compared with conventional axillary lymph node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Purushotham AD, Upponi S, Klevesath MB, et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23:4312–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32 (Discussion 4323).PubMedPubMedCentralGoogle Scholar
  5. 5.
    Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264:413–20.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    NCCN. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Version 2, 2016. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed May 2017.
  7. 7.
    Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32:1365–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Surgeons ASoB. Performance and Practice Guidelines for Axillary Lymph Node Dissection in Breast Cancer Patients. https://www.breastsurgeons.org/statements/guidelines/PerformancePracticeGuidelines_ALND.pdf. Accessed May 2017.
  9. 9.
    Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27:2946–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Caudle AS, Hunt KK, Tucker SL, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19:3144–51.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mamtani A, Patil S, Van Zee KJ, et al. Age and receptor status do not indicate the need for axillary dissection in patients with sentinel lymph node metastases. Ann Surg Oncol. 2016;23:3481–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bland KI, Scott-Conner, C. E., Menck, H., et al. Axillary dissection in breast-conserving surgery for stage I and II breast cancer: a National Cancer Data Base study of patterns of omission and implications for survival. J Am Coll Surg. 1999;188:586–95 (Discussion 595–6).CrossRefPubMedGoogle Scholar
  13. 13.
    Enger SM, Thwin SS, Buist DS, et al. Breast cancer treatment of older women in integrated health care settings. J Clin Oncol. 2006;24:4377–83.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Freedman RA, Partridge AH. Management of breast cancer in very young women. Breast. 2013;22(Suppl 2):S176–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer. 2014;17:301–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Chollet-Hinton L, Anders CK, Tse CK, et al. Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: a case-control study. Breast Cancer Res. 2016;18:79.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gartner R, Jensen MB, Kronborg L, et al. Self-reported arm-lymphedema and functional impairment after breast cancer treatment: a nationwide study of prevalence and associated factors. Breast. 2010;19:506–15.CrossRefPubMedGoogle Scholar
  18. 18.
    Chung A, Gangi A, Mirocha J, et al. Applicability of the ACOSOG Z0011 criteria in women with high-risk node-positive breast cancer undergoing breast conserving surgery. Ann Surg Oncol. 2015;22:1128–32.CrossRefPubMedGoogle Scholar
  19. 19.
    King TA, Morrow M. Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy. Nat Rev Clin Oncol. 2015;12:335–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Mohiuddin JJ, Deal AM, Carey LA, et al. Neoadjuvant systemic therapy use for younger patients with breast cancer treated in different types of cancer centers across the United States. J Am Coll Surg. 2016;223:717–728 e4.Google Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Cecilia T. Ong
    • 1
  • Samantha M. Thomas
    • 2
    • 3
  • Rachel C. Blitzblau
    • 1
    • 3
  • Oluwadamilola M. Fayanju
    • 1
    • 3
  • Tristen S. Park
    • 1
  • Jennifer K. Plichta
    • 1
    • 3
  • Laura H. Rosenberger
    • 1
    • 3
  • Terry Hyslop
    • 2
    • 3
  • E. Shelley Hwang
    • 1
    • 3
  • Rachel A. Greenup
    • 1
    • 3
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke UniversityDurhamUSA
  3. 3.Duke Cancer Institute, Duke UniversityDurhamUSA

Personalised recommendations