Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancer

Petrik, David; McCready, David R.; Sawka, Carol; Goel, Vivek

doi:10.1002/jso.10198

Cited by 37 publications

(25 citation statements)

References 35 publications

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“…The expertise of the individual surgeon as well as pathologist on the LNY was considered a strong predictor for the LNY [20,22,23]. However, in our study cohort multivariate analyses could not detect any significant influence of lymph node retrieval by the involved specialists as well as specific interactions between them.…”

Section: Discussioncontrasting

confidence: 54%

Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection

et al. 2014

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BackgroundNeoadjuvant chemotherapy (NC) is an established therapy in breast cancer, able to downstage positive axillary lymph nodes, but might hamper their detectibility. Even if clinical observations suggest lower lymph node yield (LNY) after NC, data are inconclusive and it is unclear whether NC dependent parameters influence detection rates by axillary lymph node dissection (ALND).MethodsWe analyzed retrospectively the LNY in 182 patients with ALND after NC and 351 patients with primary ALND. Impact of surgery or pathological examination and specific histomorphological alterations were evaluated. Outcome analyses regarding recurrence rates, disease free (DFS) and overall survival (OS) were performed.ResultsAxillary LNY was significantly lower in the NC in comparison to the primary surgery group (median 13 vs. 16; p < 0.0001). The likelihood of incomplete axillary staging was four times higher in the NC group (14.8% vs. 3.4%, p < 0.0001). Multivariate analyses excluded any influence by surgeon or pathologist. However, the chemotherapy dependent histological feature lymphoid depletion was an independent predictive factor for a lower LNY. Outcome analyses revealed no significant impact of the LNY on local and regional recurrence rates as well as DFS and OS, respectively.ConclusionNC significantly reduces the LNY by ALND and has profound effects on the histomorphological appearance of lymph nodes. The current recommendations for a minimum removal of 10 lymph nodes by ALND are clearly compromised by the clinically already established concept of NC. The LNY of less than 10 by ALND after NC might not be indicative for an insufficient axillary staging.

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Section: Discussioncontrasting

confidence: 54%

Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection

et al. 2014

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“…How these various factors impact the LN yields for SBA is not known but the same factors are likely relevant, as studies in other tumor types have noted the importance of these same factors. 35, 36 In a prior SEER registry study, assessment of ≥8 LNs was identified to be the optimal cut-point for discriminating differences in cancer-specific survival. 21 We therefore utilized this cut-point in the present analysis as a means to minimize the potential effects of stage-migration.…”

Section: Discussionmentioning

confidence: 99%

A Population-Based Comparison of Adenocarcinoma of the Large and Small Intestine: Insights Into a Rare Disease

et al. 2011

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Background Because of its rarity, adenocarcinoma of the small intestine is frequently compared to adenocarcinoma of the colon, though the validity of this comparison is not known. Methods Patients with small (SBA) and large bowel adenocarcinoma (LBA) diagnosed between 1988–2007 were identified from the SEER registry. Age-standardized incidence and mortality rates were determined. Cancer-specific survival (CSS) stratified by stage and by number of assessed lymph nodes was calculated. Results A total of 4,518 and 261,521 patients with SBA and LBA, respectively, were identified. In comparison to LBA, patients with SBA were younger and presented with higher stage and histological grade. The age-standardized incidence rates decreased for LBA (−1.24%/year) but increased for SBA (+1.47%/year). While age-standardized mortality rates decreased for both LBA and SBA, the decreases were more pronounced for LBA. Five-year cancer-specific survival (CSS) was worse for resected SBA compared with resected LBA, though this difference diminished when comparing cases having ≥8 lymph nodes assessed. The relative reduction in CSS when selecting ≥8 lymph nodes was much greater for duodenal as opposed to jejunal/ileal subsite of the small bowel. With nodal selection the absolute difference in CSS between LBA and SBA for stages I, II, and III was 13%, 15.9%, and 18.5%, respectively. Conclusions Adequate nodal assessment is much less common in SBA than LBA; and it appears that SBA, in particular duodenal adenocarcinoma, is understaged. Even after corrections to minimize the effect of stage migration and inadequate lymph node evaluation, SBA demonstrated distinctly worse CSS than LBA.

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“…Others have shown that surgeon training and academic affiliation also influence the quality and degree of axillary node dissection. 23, 24 …”

Section: Discussionmentioning

confidence: 99%

Surgeon Characteristics and Use of Breast Conservation Surgery in Women With Early Stage Breast Cancer

Hershman

Buono²,

Jacobson³

et al. 2009

Annals of Surgery

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Background Most women with localized breast cancer (BC) have a choice between mastectomy and breast conserving surgery (BCS). Aside from clinical factors, this decision may be associated with surgeon and patient characteristics. We investigated the effect of surgeon characteristics on the BCS rate. Methods We used the SEER-Medicare database to identify women >65 years, diagnosed with stages I-II BC, between 1991–2002, and used the Physician Unique Identification Number linked to the American Medical Association Masterfile to obtain information on surgeons. We investigated the association of patient demographic, tumor, and surgeon-related factors with receipt of BCS, using Generalized Estimating Equations to control for clustering. Results Of 56,768 women with BC, 30,006 (53%) underwent BCS while 26,762 (47%) underwent mastectomy. From 1991 to 2002, the proportion of patients undergoing BCS increased from 35% to 60%. In a multivariate analysis, patients who received BCS were younger, of higher SES, and had more favorable tumor characteristics. They were also more likely to be black and live in metropolitan areas. Women who underwent BCS were more likely to have surgeons who were female (OR=1.40; 95%CI 1.25–1.55), US-trained (OR=1.12; 95%CI 1.02–1.22), with a larger patient panel (OR=1.29; 95%CI 1.21–1.39), and completed training after 1975 (OR=1.16; 95%CI 1.08–1.25), than surgeons of patients who underwent mastectomy. Conclusions Surgeon characteristics, such as gender, training, year of graduation and volume, are small but significant independent predictor of BCS. Efforts to differentiate whether these associations reflect patients’ preferences, quality of physician training, surgeon attitudes, physician-patient communication, or other effects on decision-making are warranted.

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Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancer

Cited by 37 publications

References 35 publications

Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection

Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection

A Population-Based Comparison of Adenocarcinoma of the Large and Small Intestine: Insights Into a Rare Disease

Surgeon Characteristics and Use of Breast Conservation Surgery in Women With Early Stage Breast Cancer

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