A feasibility study on breast cancer patients with 1–2 positive sentinel lymph nodes to avoid axillary lymph node dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Hailin ,  MA Xiaogan

Department of General Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P. R. China;

Corresponding author：

MA Xiaogan, Email: maxg2011@sina.com

Keywords：

breast cancer; sentinel lymph node; axillary lymph node dissection; Z0011 clinical trials

DOI：

10.7507/1007-9424.201704009

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the feasibility of breast cancer patients in China with 1–2 positive sentinel lymph nodes (SLN) to avoid axillary lymph node dissection (ALND). Methods A total of 328 patients who received sentinel lymph node biopsy (SLNB) in our hospital from 2010 to 2016 were collected retrospectively, and patients met the criteria of Z0011 clinical trials (which required no acceptance of neoadjuvant therapy, clinical tumor size was in T1/T2 stage, two or less positive SLNs were detected, received breast-conservation surgery, acceptance of whole breast radiotherapy after surgery and neoadjuvant systemic treatment) were enrolled to breast-conservation group. Patients met the criteria of Z0011 clinical trials, excepting the surgery (received non-breast-conservation surgery), were enrolled to non- breast-conservation group. Comparison of clinicopathological features between the breast-conservation group/non-breast-conservation group and the Z0011 ALND group was performed. Results Among the 328 patients, only 29 patients (8.8%) completely correspond with the results of Z0011 clinical trials. There was no statistical significance between the breast-conservation group and the Z0011 ALND group in the age, clinical T stage, expression of estrogen (ER), expression of progesterone (PR), pathological type, histological grade, number of positive lymph nodes, and incidence of non-sentinel node metastasis (P>0.05). A total of 81 patients were included in the non-breast-conservation group. It showed no statistical significance between the non-breast-conservation group and the Z0011 ALND group in expressions of ER and PR, and histological grade (P>0.05), while there was statistically significant difference in age, clinical T stage, pathological type,number of positive lymph nodes, and incidence of non-sentinel node metastasis (P<0.05). Patients in the non-breast-conservation group showed a lower age, higher percentage of lobular carcinoma and T2 stage, more positive lymph nodes, and high incidence of non-sentinel node metastasis. Conclusion It’s feasible for Z0011 clinical trials results to be used in the clinical practice of our country, but the actual situation of breast conservation in our country may lead to low adaptive population.

Citation： YANG Hailin, MA Xiaogan. A feasibility study on breast cancer patients with 1–2 positive sentinel lymph nodes to avoid axillary lymph node dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1085-1089. doi: 10.7507/1007-9424.201704009 Copy

1.	Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol, 2005, 23(30): 7703-7720.
2.	Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 2011, 22(8): 1736-1747.
3.	van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol, 2011, 37(4): 290-299.
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(3): 426-432.
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(3): 413-420.
6.	Boguševičius A, Čepulienė D. Quality of life after sentinel lymph node biopsy versus complete axillary lymph node dissection in early breast cancer: a 3-year follow-up study. Medicina (Kaunas), 2013, 49(3): 111-117.
7.	赵杰, 欧江华, 杨亮, 等. 乳腺癌非前哨淋巴结转移的相关危险因素分析. 中国普通外科杂志, 2014, 23(5): 661-664.
8.	王慧, 王靖, 高纪东, 等. 乳腺癌非前哨淋巴结转移的预测因素分析. 中华肿瘤防治杂志, 2014, 21(22): 1825-1828.
9.	陈宏亮, 丁昂, 王富文, 等. 前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移影响因素分析. 复旦学报(医学版), 2015, 42(4): 460-466.
10.	van la Parra RF, Peer PG, de Roos WK, et al. A simple risk score to predict the presence of non-sentinel lymph node metastases in breast cancer patients with a positive sentinel node. World J Surg, 2014, 38(5): 1070-1076.
11.	International Breast Cancer Study Group; Rudenstam CM, Zahrieh D, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol, 2006, 24(3): 337-344.
12.	Veronesi U, Orecchia R, Zurrida S, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol, 2005, 16(3): 383-388.
13.	Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol, 2003, 10(2): 126-130.
14.	Delpech Y, Bricou A, Lousquy R, et al. The exportability of the ACOSOG Z0011 criteria for omitting axillary lymph node dissection after positive sentinel lymph node biopsy findings: a multicenter study. Ann Surg Oncol, 2013, 20(8): 2556-2561.
15.	Yi M, Kuerer HM, Mittendorf EA, et al. Impact of the American college of surgeons oncology group Z0011 criteria applied to a contemporary patient population. J Am Coll Surg, 2013, 216(1): 105-113.
16.	Dengel LT, Van Zee KJ, King TA, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol, 2014, 21(1): 22-27.
17.	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(10): 3144-3151.
18.	National Comprehensive Cancer Network. Clinical practice guidelines in oncology: breast, version1.2012. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
19.	陈锦飞, 顾东英. 2015 St.Gallen 及 ASCO 会议乳腺癌治疗进展. 中国肿瘤外科杂志, 2015, 7(3): 150-153.
20.	Gannan E, Khoo J, Nightingale S, et al. Management of early node-positive breast cancer in Australia: a multicentre study. Breast J, 2016, 22(4): 413-419.
21.	Setton J, Cody H, Tan L, et al. Radiation field design and regional control in sentinel lymph node-positive breast cancer patients with omission of axillary dissection. Cancer, 2012, 118(8): 1994-2003.
22.	van la Parra RF, de Wilt JH, Mol SJ, et al. Is SLN biopsy alone safe in SLN positive breast cancer patients? Breast J, 2015, 21(6): 621-626.
23.	Pilewskie M, Mautner SK, Stempel M, et al. Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era? Ann Surg Oncol, 2016, 23(4): 1123-1128.
24.	Roberts A, Nofech-Mozes S, Youngson B, et al. The importance of applying ACOSOG Z0011 criteria in the axillary management of invasive lobular carcinoma: a multi-institutional cohort study. Ann Surg Oncol, 2015, 22(10): 3397-3401.
25.	刘淼, 王殊, 杨后圃, 等. ACOSOG Z0011 试验结果对中国乳腺外科医生临床实践影响的调查. 肿瘤防治研究, 2016, 43(1): 48-53.
26.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015 版). 中国癌症杂志, 2015, 25(9): 692-754.

1. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol, 2005, 23(30): 7703-7720.
2. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 2011, 22(8): 1736-1747.
3. van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol, 2011, 37(4): 290-299.
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(3): 426-432.
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(3): 413-420.
6. Boguševičius A, Čepulienė D. Quality of life after sentinel lymph node biopsy versus complete axillary lymph node dissection in early breast cancer: a 3-year follow-up study. Medicina (Kaunas), 2013, 49(3): 111-117.
7. 赵杰, 欧江华, 杨亮, 等. 乳腺癌非前哨淋巴结转移的相关危险因素分析. 中国普通外科杂志, 2014, 23(5): 661-664.
8. 王慧, 王靖, 高纪东, 等. 乳腺癌非前哨淋巴结转移的预测因素分析. 中华肿瘤防治杂志, 2014, 21(22): 1825-1828.
9. 陈宏亮, 丁昂, 王富文, 等. 前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移影响因素分析. 复旦学报(医学版), 2015, 42(4): 460-466.
10. van la Parra RF, Peer PG, de Roos WK, et al. A simple risk score to predict the presence of non-sentinel lymph node metastases in breast cancer patients with a positive sentinel node. World J Surg, 2014, 38(5): 1070-1076.
11. International Breast Cancer Study Group; Rudenstam CM, Zahrieh D, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol, 2006, 24(3): 337-344.
12. Veronesi U, Orecchia R, Zurrida S, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol, 2005, 16(3): 383-388.
13. Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol, 2003, 10(2): 126-130.
14. Delpech Y, Bricou A, Lousquy R, et al. The exportability of the ACOSOG Z0011 criteria for omitting axillary lymph node dissection after positive sentinel lymph node biopsy findings: a multicenter study. Ann Surg Oncol, 2013, 20(8): 2556-2561.
15. Yi M, Kuerer HM, Mittendorf EA, et al. Impact of the American college of surgeons oncology group Z0011 criteria applied to a contemporary patient population. J Am Coll Surg, 2013, 216(1): 105-113.
16. Dengel LT, Van Zee KJ, King TA, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol, 2014, 21(1): 22-27.
17. 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(10): 3144-3151.
18. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: breast, version1.2012. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
19. 陈锦飞, 顾东英. 2015 St.Gallen 及 ASCO 会议乳腺癌治疗进展. 中国肿瘤外科杂志, 2015, 7(3): 150-153.
20. Gannan E, Khoo J, Nightingale S, et al. Management of early node-positive breast cancer in Australia: a multicentre study. Breast J, 2016, 22(4): 413-419.
21. Setton J, Cody H, Tan L, et al. Radiation field design and regional control in sentinel lymph node-positive breast cancer patients with omission of axillary dissection. Cancer, 2012, 118(8): 1994-2003.
22. van la Parra RF, de Wilt JH, Mol SJ, et al. Is SLN biopsy alone safe in SLN positive breast cancer patients? Breast J, 2015, 21(6): 621-626.
23. Pilewskie M, Mautner SK, Stempel M, et al. Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era? Ann Surg Oncol, 2016, 23(4): 1123-1128.
24. Roberts A, Nofech-Mozes S, Youngson B, et al. The importance of applying ACOSOG Z0011 criteria in the axillary management of invasive lobular carcinoma: a multi-institutional cohort study. Ann Surg Oncol, 2015, 22(10): 3397-3401.
25. 刘淼, 王殊, 杨后圃, 等. ACOSOG Z0011 试验结果对中国乳腺外科医生临床实践影响的调查. 肿瘤防治研究, 2016, 43(1): 48-53.
26. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2015 版). 中国癌症杂志, 2015, 25(9): 692-754.

Previous Article
Selection of therapeutic method for isolated iliac aneurysms
Next Article
Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A feasibility study on breast cancer patients with 1–2 positive sentinel lymph nodes to avoid axillary lymph node dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content