André Hennigs1, Melitta Köpke1, Manuel Feißt2, Fabian Riedel1, Mahdi Rezai3, Ulrike Nitz4, Mareike Moderow5, Michael Golatta1, Christof Sohn1, Andreas Schneeweiss6, Jörg Heil7. 1. Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. 2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. 3. European Breast Center, Luisen Hospital, Düsseldorf, Germany. 4. Evangelical Hospital Johanniter Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany. 5. West German Breast Center Ltd, Düsseldorf, Germany. 6. National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany. 7. Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. joerg.heil@med.uni-heidelberg.de.
Abstract
PURPOSE: In the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial, patients with 1 or 2 tumour-involved sentinel lymph nodes (SLNs) gained no benefit from completion axillary lymph dissection (cALND). We examined implementation of evidence from this trial into routine clinical management. METHODS: Data were included from patients diagnosed with primary breast cancer in German breast cancer units between 2008 and 2015 and analysed retrospectively from a prospective maintained database. Descriptive analyses assessed time-trend changes in axillary surgery. Factors associated with cALND in patients with 1 or 2 positive SLNs were identified using multivariable logistic regression analysis. RESULTS: Overall, 179 breast cancer units provided data for 188,909 patients, of whom 13,741 (7.3%) had pT1/2cN0M0 invasive breast cancer with 1 or 2 tumour-involved SLNs and underwent breast-conserving surgery and adjuvant radiotherapy. cALND use decreased from 94.6% in 2008 to 46.9% in 2015 (p < 0.001). In multivariable analyses, the following factors were associated with cALND: fewer removed SLNs; two tumour-affected SLNs; younger age; lower annual case volume per hospital; higher tumour grade and lymphovascular invasion. No statistically significant influence was detected for hormone receptor or HER2 status. CONCLUSION: In our cohort, 7.3% of patients with primary breast cancer met the ACOSOG Z0011 inclusion criteria and could potentially have been spared the morbidity of cALND. cALND tended to be performed in patients with a higher axillary tumour burden. This study shows a shift towards less extensive axillary surgery through rapid implementation of new clinical trial evidence into routine clinical practice.
PURPOSE: In the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial, patients with 1 or 2 tumour-involved sentinel lymph nodes (SLNs) gained no benefit from completion axillary lymph dissection (cALND). We examined implementation of evidence from this trial into routine clinical management. METHODS: Data were included from patients diagnosed with primary breast cancer in German breast cancer units between 2008 and 2015 and analysed retrospectively from a prospective maintained database. Descriptive analyses assessed time-trend changes in axillary surgery. Factors associated with cALND in patients with 1 or 2 positive SLNs were identified using multivariable logistic regression analysis. RESULTS: Overall, 179 breast cancer units provided data for 188,909 patients, of whom 13,741 (7.3%) had pT1/2cN0M0 invasive breast cancer with 1 or 2 tumour-involved SLNs and underwent breast-conserving surgery and adjuvant radiotherapy. cALND use decreased from 94.6% in 2008 to 46.9% in 2015 (p < 0.001). In multivariable analyses, the following factors were associated with cALND: fewer removed SLNs; two tumour-affected SLNs; younger age; lower annual case volume per hospital; higher tumour grade and lymphovascular invasion. No statistically significant influence was detected for hormone receptor or HER2 status. CONCLUSION: In our cohort, 7.3% of patients with primary breast cancer met the ACOSOG Z0011 inclusion criteria and could potentially have been spared the morbidity of cALND. cALND tended to be performed in patients with a higher axillary tumour burden. This study shows a shift towards less extensive axillary surgery through rapid implementation of new clinical trial evidence into routine clinical practice.
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: Jane Yuet Ching Hui; Erin Burke; Kristy K Broman; Schelomo Marmor; Eric Jensen; Todd M Tuttle; Jonathan S Zager Journal: J Surg Oncol Date: 2020-12-01 Impact factor: 3.454