Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

Loza, Carlos Martín; Mandó, Pablo; Ponce, Carolina; Coló, Federico; Fabiano, Verónica; Loza, José; Costanzo, María Victoria; Nervo, Adrián; Nadal, Jorge; Pierro, Anibal Nuñez de; Chacón, Reinaldo; Contributors, Rcm Database

doi:10.1159/000488277

Cited by 6 publications

(4 citation statements)

References 29 publications

(36 reference statements)

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“…The aggressive tumour characters like high grade, ER negativity and younger age were not significantly associated with the residual axillary burden. Similar results of lack of association of aggressive tumour biology and non-SLN positivity in Z0011 eligible patients was reported in multiple studies [ 32 , 33 ]. The non-association of aggressive tumour characteristics with residual axillary burden supports omission of completion ALND in patients fulfilling Z0011 eligibility criteria.…”

Section: Discussionsupporting

confidence: 89%

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Agrawal¹,

Kewlani²,

Priya³

et al. 2021

ecancer

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Background The Z0011 trial results have shown that axillary lymph node dissection (ALND) can be avoided in cT1-2 patients undergoing breast conservation surgery with 1–2 metastatic sentinel lymph nodes (SLNs). We compared the clinicopathological characteristics of the Z0011 eligible non-screen detected breast cancer patients’ cohort with the Z0011 trial study population. Additionally, we have explored the effect of non-sentinel metastasis on adjuvant treatment decisions and survival. Methods The details of early breast cancer (EBC) patients fulfilling Z0011 eligibility criteria were retrieved from a prospectively maintained database (2013–2017) and electronic medical records. We used Statistical Package for the Social Sciences 25 and Stata V15 for the data analysis. Results 128/194 (66%) sentinel lymph node biopsy positive patients had fulfilled the Z0011 inclusion criteria. Compared to the Z0011 study, our cohort patients were younger, with more aggressive disease (higher T2, Grade 3), had a higher rate of macrometastasis (82.8% versus 58.8%) and non-SLN metastasis (48% versus 27%). The information gained by ALND had changed decisions for chemotherapy in 3% and no change of radiotherapy in Z0011 eligible patients. Further nodal positivity in completion ALND was not significantly associated with overall survival ( p = 0.86) and disease-free survival ( p = 0.5). Conclusion Z0011 eligible Indian EBC patients are significantly different from the Z0011 study population, with younger age of presentation, higher grade, a higher rate of both SLN macro metastasis and non-SLN positivity. The impact of non-sentinel metastasis on adjuvant treatment decisions and survival is minimal.

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Section: Discussionsupporting

confidence: 89%

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Agrawal¹,

Kewlani²,

Priya³

et al. 2021

ecancer

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“…The finding of a lower burden of macrometastatic non-sentinel nodes in patients with HER2-positive disease in this study is difficult to interpret, with inconsistencies in the literature. In an American series 22 , patients with triple negative disease had fewer nodal metastases than those with triple positive disease; in an Argentinian series of patients who fulfilled Z0011 trial criteria 23 , HER2 positivity was associated with a higher rate of non-sentinel node metastasis; and in an Indonesian series 24 , patients with luminal A disease had the highest rate of non-sentinel node mestastasis. There are thus inconsistencies in the influence of hormone receptor status in the development of non-sentinel node metastases.…”

Section: Discussionmentioning

confidence: 96%

Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer

et al. 2020

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Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.

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“…The association of tumor size with the probability of non-SLN metastasis has been documented in numerous studies ( 19 - 22 ). In the present study, N2/3 disease was correlated to T2 stage.…”

Section: Discussionmentioning

confidence: 98%

Analysis of factors related to N2- or N3-stage breast cancer associated with 1–2 positive sentinel lymph nodes in Chinese patients

Luo¹,

Yuan²,

Cheng³

et al. 2020

Transl Cancer Res TCR

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Background This study aims to determine the incidence of N2- or N3-stage disease in a cohort of patients with T1–T2 invasive breast cancer and one or two positive sentinel lymph nodes (SLNs), and identify the risk factors for N2/3 disease in this cohort. Methods The present study involved 298 patients with T1–T2 tumors who underwent SLN biopsy and were found to have one or two metastatic SLNs. The proportion of patients with N2/3 disease was calculated in the whole cohort, and in the T1 and T2 subgroups. Furthermore, univariate and multivariate analyses were used to identify the risk factors for N2/3 disease in the cohort. Results The final N stage, as determined by the postoperative pathological examination, was N1 for 250 (83.9%) patients, and N2 or N3 for 48 (16.1%) patients (11.41% had clinical N2 disease, while 4.70% had clinical N3 disease). Among the 156 patients with T1 tumors, 17 (10.9%) patients had N2/3 disease, while for the 142 patients with T2 tumors, 31 (21.8%) patients had N2/3 disease. T2 stage, lymphovascular invasion, and the number of positive SLNs were independent predictors of N2/3 disease in the cohort (P<0.05). Conclusions N2/3 lymph node metastasis occurs in patients with T1–T2 breast cancer, and one or two positive SLNs, particularly in patients with T2 tumors. The rate of N2/3 disease is not negligible. T2 stage, lymphovascular invasion, and the number of positive SLNs were independent predictors of N2/3 disease in the present patient population.

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Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

Cited by 6 publications

References 29 publications

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer

Analysis of factors related to N2- or N3-stage breast cancer associated with 1–2 positive sentinel lymph nodes in Chinese patients

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