Carlos A Garcia-Etienne1, Robert E Mansel2, Mariano Tomatis3, Joerg Heil4, Laura Biganzoli5, Alberta Ferrari6, Lorenza Marotti7, Adele Sgarella6, Antonio Ponti3. 1. Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Italy. Electronic address: carlos.garciaetienne@unipv.it. 2. School of Medicine, Cardiff University, United Kingdom. 3. AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA Data Centre, Turin, Italy. 4. University of Heidelberg, Germany. 5. Nuovo Ospedale di Prato, Italy; EUSOMA, Florence, Italy. 6. Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Italy. 7. EUSOMA, Florence, Italy.
Abstract
BACKGROUND: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1-2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. METHODS: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. RESULTS: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015-2016) were 0% and 83% in two centers located in different countries (p < 0.001). CONCLUSION: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.
BACKGROUND: Data from recently published trials have provided practice-changing recommendations for the surgical approach to the axilla in breast cancer. Patients with T1-2 lesions, treated with breast conservation, who have not received neoadjuvant chemotherapy and have 1-2 positive sentinel nodes (Z0011-criteria) may avoid axillary lymph node dissection (ALND). We aim to describe the dissemination of this practice in Europe over an extended period of time. METHODS: Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified cases fulfilling Z0011-criteria from 2005 to 2016 from 34 European breast centers and report trends in ALND. Data derived from Germany, Italy, Belgium, Switzerland, Austria, and Netherlands. RESULTS: 6671 patients fulfilled Z0011-criteria. Rates of ALND showed a statistically significant decrease from 2010 (89%) to 2011 (73%), reaching 46% in 2016 (p < 0.001). After multivariable analysis, factors associated with higher probability of ALND were earlier year of surgery, younger age, increasing tumor size and grade, and being operated in Italy (p < 0.001). The minimum and maximal rates of ALND in the most recent two-year period (2015-2016) were 0% and 83% in two centers located in different countries (p < 0.001). CONCLUSION: Our study demonstrates, a decrease in rates of ALND that started after year 2010 through the end of the study period. Wide differences were observed among centers and countries indicating the need to spread unified clinical guidelines in Europe to allow for homogeneous evidence-based practice patterns.
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
Authors: Juliëtte J C M van Munster; Amir H Zamanipoor Najafabadi; Nick P de Boer; Wilco C Peul; Wilbert B van den Hout; Peter Paul G van Benthem Journal: PLoS One Date: 2020-05-22 Impact factor: 3.240