The optimal treatment plan to avoid axillary lymph node dissection in early-stage breast cancer patients differs by surgical strategy and tumor subtype Journal Article


Authors: Pilewskie, M.; Zabor, E. C.; Mamtani, A.; Barrio, A. V.; Stempel, M.; Morrow, M.
Article Title: The optimal treatment plan to avoid axillary lymph node dissection in early-stage breast cancer patients differs by surgical strategy and tumor subtype
Abstract: Background: Strategies to reduce the likelihood of axillary lymph node dissection (ALND) include application of Z0011 or use of neoadjuvant chemotherapy (NAC). Indications for ALND differ by treatment plan, and nodal pathologic complete response rates after NAC vary by tumor subtype. This study compared ALND rates for cT1-2N0 tumors treated with upfront surgery versus those treated with NAC. Methods: The ALND rates for cT1-2N0 breast cancer patients were compared by tumor subtype among women undergoing upfront surgery to NAC. Multivariable analysis with control for age, cT stage, and lymphovascular invasion, and stratification by subtype was performed. Results: The study identified 1944 cancers in 1907 women who underwent sentinel lymph node (SLN) biopsy with or without ALND (669 upfront breast-conserving surgeries [BCSs], 1004 upfront mastectomies, 271 NACs). Compared with the NAC group, the ALND rates in the BCS group were lower for estrogen receptor (ER), progesterone receptor-positive (PR+), human epidermal growth factor 2-negative (HER2−) tumors (15 vs 34%; p < 0.001). The ALND rates in the upfront mastectomy group were higher than in the NAC group for HER2+ or TN tumors. In the multivariable analysis, receipt of NAC compared with upfront BCS remained significantly associated with higher odds of ALND in the ER/PR+ HER2− subtype (hazard ratio [HR], 3.35; p < 0.001), whereas NAC versus upfront mastectomy remained significantly associated with lower odds of ALND in the HER2+ and TN subtypes (HR for HER2+, 0.19, p < 0.001; HR for TN, 0.25, p = 0.007). Conclusion: The study showed that ALND rates differ according to surgery type and tumor subtype secondary to differing ALND indications and nodal response to NAC. These factors can be used to personalize treatment planning to minimize ALND risk for patients with early-stage breast cancer. © 2017, Society of Surgical Oncology.
Keywords: adult; human tissue; aged; cancer surgery; major clinical study; treatment planning; cancer patient; cancer staging; antineoplastic agent; lymph node dissection; sentinel lymph node biopsy; breast cancer; mastectomy; epidermal growth factor receptor 2; surgical approach; axillary lymph node; early cancer; partial mastectomy; intermethod comparison; neoadjuvant chemotherapy; estrogen receptor; progesterone receptor; tumor classification; lymph vessel metastasis; human; male; female; article
Journal Title: Annals of Surgical Oncology
Volume: 24
Issue: 12
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2017-11-01
Start Page: 3527
End Page: 3533
Language: English
DOI: 10.1245/s10434-017-6016-y
PROVIDER: scopus
PMCID: PMC5697709
PUBMED: 28762114
DOI/URL:
Notes: Article -- Export Date: 1 December 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Andrea Veronica Barrio
    38 Barrio
  2. Monica Morrow
    450 Morrow
  3. Emily Craig Zabor
    131 Zabor
  4. Michelle Moccio Stempel
    131 Stempel
  5. Anita   Mamtani
    18 Mamtani