Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer

Joyce, Doireann; Manning, Aidan; Carter, M.; Hill, Arnold D.; Kell, Malcolm R.; Barry, Mitchel

doi:10.1007/s10549-015-3549-2

Cited by 22 publications

(15 citation statements)

References 30 publications

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“…A recent meta-analysis shows an advantage of axillary surgery both for overall survival and recurrence-free survival. 40 It was conducted on patients with operable primary breast cancer to determine the clinical impact of ALND in the treatment of invasive breast cancer. ALND seems to positively affect overall and recurrence-free survival from breast cancer.…”

Section: Author's Personal Copymentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

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Section: Author's Personal Copymentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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“…To the best of our knowledge there is no literature on the ‘optimal’ number of removed lymph nodes in our focus group. Joyce et al [47] reports on patients without an ALNE to have a significantly higher risk of axillary recurrence and a slightly elevated mortality rate. Liang et al confirm the raised local recurrence rates in elderly cN0 patients but do not find an OAS effect.…”

Section: Discussionmentioning

confidence: 99%

Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival?

Ebner

Wöckel

Schwentner³

et al. 2019

BMC Cancer

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BackgroundThe decision making process for axillary dissection has changed in recent years for patients with early breast cancer and positive sentinel lymph nodes (LN). The question now arises, what is the optimal surgical treatment for patients with positive axillary LN (pN+). This article tries to answer the following questions:Is there a survival benefit for breast cancer patients with 3 or more positive LN (pN3+) and with more than 10 removed LN?Is there a survival benefit for high risk breast cancer patients (triple negative or Her2 + breast cancer) and with 3 or more positive LN (pN3+) with more than 10 removed LN?In pN + patients is the prognostic value of the lymph node ratio (LNR) of pN+/pN removed impaired if 10 or less LN are removed?MethodsA retrospective database analysis of the multi center cohort database BRENDA (breast cancer under evidence based guidelines) with data from 9625 patients from 17 breast centers was carried out. Guideline adherence was defined by the 2008 German National consensus guidelines.Results2992 out of 9625 patients had histological confirmed positive lymph nodes. The most important factors for survival were intrinsic sub types, tumor size and guideline adherent chemo- and hormonal treatment (and age at diagnosis for overall survival (OAS)). Uni-and multivariable analyses for recurrence free survival (RFS) and OAS showed no significant survival benefit when removing more than 10 lymph nodes even for high-risk patients. The mean and median of LNR were significantly higher in the pN+ patients with ≤10 excised LN compared to patients with > 10 excised LN. LNR was in both, uni-and multivariable, analysis a highly significant prognostic factor for RFS and OAS in both subgroups of pN + patients with less respective more than 10 excised LN. Multivariable COX regression analysis was adjusted by age, tumor size, intrinsic sub types and guideline adherent adjuvant systemic therapy.ConclusionThe removal of more than 10 LN did not result in a significant survival benefit even in high risk pN + breast cancer patients.

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“…2). TdLNs are in certain circumstances surgically removed together with the tumor mass in order to treat or prevent lymphatic metastasis, depending on the histologic type, stage and metastatic status of the tumor [186][187][188]. In cases in which surgical lymphadenectomy is not associated with significant survival benefits, we propose that the specific targeting of the tdLNs with lymphatic-targeting vaccines should be investigated as candidate approach for cancer immunotherapy.…”

Section: Targeting the Tumor-draining Lymph Nodesmentioning

confidence: 99%

Exploiting lymphatic vessels for immunomodulation: Rationale, opportunities, and challenges

Maisel

Sasso

Potin

et al. 2017

Advanced Drug Delivery Reviews

102

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Lymphatic vessels are the primary route of communication from peripheral tissues to the immune system; as such, they represent an important component of local immunity. In addition to their transport functions, new immunomodulatory roles for lymphatic vessels and lymphatic endothelial cells have come to light in recent years, demonstrating that lymphatic vessels help shape immune responses in a variety of ways: promoting tolerance to self-antigens, archiving antigen for later presentation, dampening effector immune responses, and resolving inflammation, among others. In addition to these new biological insights, the growing field of immunoengineering has begun to explore therapeutic approaches to utilize or exploit the lymphatic system for immunotherapy.

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Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer

Cited by 22 publications

References 30 publications

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival?

Exploiting lymphatic vessels for immunomodulation: Rationale, opportunities, and challenges

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