Fabian Riedel1, Jörg Heil1, Manuel Feißt2, Mahdi Rezai3, Mareike Moderow4, Christof Sohn1, Florian Schütz1, Michael Golatta1, André Hennigs5. 1. Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. 2. Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. 3. European Breast Center, Luisen Hospital, Luise-Rainer-Str. 6-10, 40235, Düsseldorf, Germany. 4. West German Breast Center Ltd, Bahlenstr. 180, 40589, Düsseldorf, Germany. 5. Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. andre.hennigs@med.uni-heidelberg.de.
Abstract
PURPOSE: In the ACOSOG Z0011 trial, patients with primary breast cancer (BC) and 1-2 tumor-involved sentinel lymph nodes (SLN) undergoing breast-conserving surgery gained no benefit from completing axillary lymph node dissection (cALND). This paper reports cALND rates performed in clinical routine on patients who would meet the Z0011 criteria. Further, patients still received cALND were analyzed concerning the number of non-sentinel metastases (NSM) to estimate occult axillary tumor burden. METHODS: Data were retrospectively analyzed from patients treated in 179 German breast centers between 2008 and 2015. Time-trend rates were determined for cALND regarding the presence of axillary macrometastases or micrometastases. Descriptive statistics were used to report the number of NSM depending on the number of SLN removed, tumor-involved SLN, tumor stage (pT1-2), and immunohistochemical subtype. Factors associated with NSM were identified using multivariable logistic regression. RESULTS: Altogether, data for 188,909 patients were available, of whom 13,741 (7.3%) were identified eligible for the Z0011 criteria. For these patients, the cALND rate for macrometastases declined from 96.4% in 2008 to 49.7% in 2015, for micrometastases from 86.7 to 5.9%. In total 9773 patients still received cALND, 33.4% of whom had NSM. The NSM rates were: 38.8% for pN(1/1sn), 28.6% for pN(1/2sn), and 50.9% for pN(2/2sn). Hormone receptor (HR) positive/HER2+ showed the highest NSM rate (41.6%), HR-/HER2- the lowest rate (29.4%). CONCLUSIONS: The rate of cALND for ACOSOG Z0011 eligible patients has decreased substantially in routine care in our nationwide cohort. Our data reveal a relatively high prevalence of additional axillary NSM tumor burden.
PURPOSE: In the ACOSOG Z0011 trial, patients with primary breast cancer (BC) and 1-2 tumor-involved sentinel lymph nodes (SLN) undergoing breast-conserving surgery gained no benefit from completing axillary lymph node dissection (cALND). This paper reports cALND rates performed in clinical routine on patients who would meet the Z0011 criteria. Further, patients still received cALND were analyzed concerning the number of non-sentinel metastases (NSM) to estimate occult axillary tumor burden. METHODS: Data were retrospectively analyzed from patients treated in 179 German breast centers between 2008 and 2015. Time-trend rates were determined for cALND regarding the presence of axillary macrometastases or micrometastases. Descriptive statistics were used to report the number of NSM depending on the number of SLN removed, tumor-involved SLN, tumor stage (pT1-2), and immunohistochemical subtype. Factors associated with NSM were identified using multivariable logistic regression. RESULTS: Altogether, data for 188,909 patients were available, of whom 13,741 (7.3%) were identified eligible for the Z0011 criteria. For these patients, the cALND rate for macrometastases declined from 96.4% in 2008 to 49.7% in 2015, for micrometastases from 86.7 to 5.9%. In total 9773 patients still received cALND, 33.4% of whom had NSM. The NSM rates were: 38.8% for pN(1/1sn), 28.6% for pN(1/2sn), and 50.9% for pN(2/2sn). Hormone receptor (HR) positive/HER2+ showed the highest NSM rate (41.6%), HR-/HER2- the lowest rate (29.4%). CONCLUSIONS: The rate of cALND for ACOSOG Z0011 eligible patients has decreased substantially in routine care in our nationwide cohort. Our data reveal a relatively high prevalence of additional axillary NSM tumor burden.
Authors: Volker Moebus; Christian Jackisch; Hans-Joachim Lueck; Andreas du Bois; Christoph Thomssen; Christian Kurbacher; Walther Kuhn; Ulrike Nitz; Andreas Schneeweiss; Jens Huober; Nadia Harbeck; Gunter von Minckwitz; Ingo B Runnebaum; Axel Hinke; Rolf Kreienberg; Gottfried E Konecny; Michael Untch Journal: J Clin Oncol Date: 2010-05-10 Impact factor: 44.544
Authors: Armando E Giuliano; Linda McCall; Peter Beitsch; Pat W Whitworth; Peter Blumencranz; A Marilyn Leitch; Sukamal Saha; Kelly K Hunt; Monica Morrow; Karla Ballman Journal: Ann Surg Date: 2010-09 Impact factor: 12.969
Authors: David N Krag; Stewart J Anderson; Thomas B Julian; Ann M Brown; Seth P Harlow; Joseph P Costantino; Takamaru Ashikaga; Donald L Weaver; Eleftherios P Mamounas; Lynne M Jalovec; Thomas G Frazier; R Dirk Noyes; André Robidoux; Hugh Mc Scarth; Norman Wolmark Journal: Lancet Oncol Date: 2010-10 Impact factor: 41.316
Authors: Timothy J Whelan; Ivo A Olivotto; Wendy R Parulekar; Ida Ackerman; Boon H Chua; Abdenour Nabid; Katherine A Vallis; Julia R White; Pierre Rousseau; Andre Fortin; Lori J Pierce; Lee Manchul; Susan Chafe; Maureen C Nolan; Peter Craighead; Julie Bowen; David R McCready; Kathleen I Pritchard; Karen Gelmon; Yvonne Murray; Judy-Anne W Chapman; Bingshu E Chen; Mark N Levine Journal: N Engl J Med Date: 2015-07-23 Impact factor: 91.245
Authors: Armando E Giuliano; Karla V Ballman; Linda McCall; Peter D Beitsch; Meghan B Brennan; Pond R Kelemen; David W Ollila; Nora M Hansen; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Kelly K Hunt; Monica Morrow Journal: JAMA Date: 2017-09-12 Impact factor: 56.272
Authors: Armando E Giuliano; Karla Ballman; Linda McCall; Peter Beitsch; Pat W Whitworth; Peter Blumencranz; A Marilyn Leitch; Sukamal Saha; Monica Morrow; Kelly K Hunt Journal: Ann Surg Date: 2016-09 Impact factor: 12.969
Authors: Umberto Veronesi; Giovanni Paganelli; Giuseppe Viale; Alberto Luini; Stefano Zurrida; Viviana Galimberti; Mattia Intra; Paolo Veronesi; Chris Robertson; Patrick Maisonneuve; Giuseppe Renne; Concetta De Cicco; Francesca De Lucia; Roberto Gennari Journal: N Engl J Med Date: 2003-08-07 Impact factor: 91.245