BACKGROUND: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial concluded that axillary lymph node dissection (ALND) may not be necessary for all patients with sentinel lymph node (SLN) metastasis undergoing breast-conserving therapy (BCT). The aim of this study was to assess applicability of Z0011 results to our patient population and determine what percentage may be affected by these results. STUDY DESIGN: Patients with clinical T1-2, N0 breast cancer, treated with surgery first between 1994 and 2009, who had 1 to 2 positive SLNs, were included in this study. Kaplan-Meier survival curves were calculated and log-rank used to compare overall survival (OS) and disease-free survival (DFS) for ALND vs SLN dissection (SLND) alone in 2 patient populations: patients undergoing BCT or total mastectomy (TM) and patients undergoing BCT only. RESULTS: Of 861 patients, 188 (21.8%) underwent SLND alone. Of 488 (56.7%) patients who underwent BCT, 125 (25.6%) had SLND alone. Of 412 patients undergoing TM, 67 (16.3%) had SLND alone. Patients undergoing ALND were significantly younger, had larger tumors, macrometastasis, and extranodal extension in both populations. Compared with the Z0011 cohort, our BCT patients had more T1 tumors (76.0% vs 69.3%, p = 0.01) and more grade II to III tumors (87.3% vs 76.2%, p < 0.0001). After adjusting for T-stage, there were no significant differences in DFS and OS between patients undergoing SLND alone or ALND in both populations. CONCLUSIONS: Examination of our breast cancer patients with Z0011 trial criteria suggests that almost 75% of SLN-positive patients would be candidates to avoid ALND if they undergo BCT.
BACKGROUND: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial concluded that axillary lymph node dissection (ALND) may not be necessary for all patients with sentinel lymph node (SLN) metastasis undergoing breast-conserving therapy (BCT). The aim of this study was to assess applicability of Z0011 results to our patient population and determine what percentage may be affected by these results. STUDY DESIGN:Patients with clinical T1-2, N0 breast cancer, treated with surgery first between 1994 and 2009, who had 1 to 2 positive SLNs, were included in this study. Kaplan-Meier survival curves were calculated and log-rank used to compare overall survival (OS) and disease-free survival (DFS) for ALND vs SLN dissection (SLND) alone in 2 patient populations: patients undergoing BCT or total mastectomy (TM) and patients undergoing BCT only. RESULTS: Of 861 patients, 188 (21.8%) underwent SLND alone. Of 488 (56.7%) patients who underwent BCT, 125 (25.6%) had SLND alone. Of 412 patients undergoing TM, 67 (16.3%) had SLND alone. Patients undergoing ALND were significantly younger, had larger tumors, macrometastasis, and extranodal extension in both populations. Compared with the Z0011 cohort, our BCT patients had more T1 tumors (76.0% vs 69.3%, p = 0.01) and more grade II to III tumors (87.3% vs 76.2%, p < 0.0001). After adjusting for T-stage, there were no significant differences in DFS and OS between patients undergoing SLND alone or ALND in both populations. CONCLUSIONS: Examination of our breast cancerpatients with Z0011 trial criteria suggests that almost 75% of SLN-positive patients would be candidates to avoid ALND if they undergo BCT.
Authors: Elizabeth A Mittendorf; Kelly K Hunt; Judy C Boughey; Roland Bassett; Amy C Degnim; Robyn Harrell; Min Yi; Funda Meric-Bernstam; Merrick I Ross; Gildy V Babiera; Henry M Kuerer; Rosa F Hwang Journal: Ann Surg Date: 2012-01 Impact factor: 12.969
Authors: G Cserni; D Gregori; F Merletti; A Sapino; M P Mano; A Ponti; S Sandrucci; B Baltás; G Bussolati Journal: Br J Surg Date: 2004-10 Impact factor: 6.939
Authors: J Michael Guenther; Nora M Hansen; L Andrew DiFronzo; Armando E Giuliano; J Craig Collins; Baiba L Grube; Theodore X O'Connell Journal: Arch Surg Date: 2003-01
Authors: Karl Y Bilimoria; David J Bentrem; Nora M Hansen; Kevin P Bethke; Alfred W Rademaker; Clifford Y Ko; David P Winchester; David J Winchester Journal: J Clin Oncol Date: 2009-04-13 Impact factor: 44.544
Authors: Fabian Riedel; Jörg Heil; Manuel Feißt; Mahdi Rezai; Mareike Moderow; Christof Sohn; Florian Schütz; Michael Golatta; André Hennigs Journal: Breast Cancer Res Treat Date: 2019-06-24 Impact factor: 4.872
Authors: Savitri Krishnamurthy; Therese Bevers; Henry M Kuerer; Benjamin Smith; Wei Tse Yang Journal: AJR Am J Roentgenol Date: 2016-12-08 Impact factor: 3.959
Authors: Justin S Poling; Theodore N Tsangaris; Pedram Argani; Ashley Cimino-Mathews Journal: Breast Cancer Res Treat Date: 2014-10-16 Impact factor: 4.872
Authors: Holly Caretta-Weyer; Caprice G Greenberg; Lee G Wilke; Jennifer Weiss; Noelle K LoConte; Marquita Decker; Nicole M Steffens; Maureen A Smith; Heather B Neuman Journal: Ann Surg Oncol Date: 2013-12 Impact factor: 5.344
Authors: Monica Morrow; Kimberly J Van Zee; Sujata Patil; Oriana Petruolo; Anita Mamtani; Andrea V Barrio; Deborah Capko; Mahmoud El-Tamer; Mary L Gemignani; Alexandra S Heerdt; Laurie Kirstein; Melissa Pilewskie; George Plitas; Virgilio S Sacchini; Lisa M Sclafani; Alice Ho; Hiram S Cody Journal: Ann Surg Date: 2017-09 Impact factor: 12.969