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21.07.2020 | Epidemiology

Evaluating the impact of axillary dissection on recurrence-free survival by extent of nodal disease in invasive lobular carcinoma of the breast

verfasst von: Mary Kathryn Abel, Kelly Fahrner-Scott, Jasmine Wong, Michael Alvarado, Cheryl Ewing, Laura J. Esserman, Catherine Park, Rita A. Mukhtar

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 3/2020

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Abstract

Purpose

Clinical trials have shown that axillary lymph node dissection (ALND) can be avoided for many breast cancer patients with limited nodal involvement. However, whether its omission is safe for those with invasive lobular carcinoma (ILC) is still questioned. We sought to evaluate the impact of ALND on recurrence-free survival (RFS) by extent of nodal disease in patients with ILC.

Methods

We performed a retrospective, cross-sectional analysis of ILC patients treated between 1990 and 2019 at our institution. Patients underwent either breast conservation surgery (BCS) or mastectomy. We used univariate and multivariate statistics in Stata 14.2 to evaluate associations between extent of axillary surgery and time to recurrence stratified by nodal burden.

Results

Of 520 cases, 387 (78.4%) were node negative, 74 (14.9%) had 1–2 positive nodes, and 59 (11.4%) had three or more positive nodes. Most patients (93.3%) had hormone receptor-positive disease, and 94.8% had low or intermediate-grade tumors. The rate of ALND significantly decreased over time (p < 0.002). Using a multivariate model, there was no significant difference in RFS estimates based on receipt of ALND (HR = 0.53, 95% CI 0.17–1.64, p = 0.27), which also held true for patients with 1–2 positive nodes using a test of interaction (HR = 0.91, 95% CI 0.12–6.76, p = 0.92).

Conclusions

These findings support the safety of omitting ALND in selected patients with ILC. Further studies of axillary management in ILC and imaging tools to predict nodal involvement and therapeutic response are warranted.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM et al (2010) Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. Trans Meet Am Surg Assoc 128:12–21. https://doi.org/10.1097/sla.0b013e3181f08f32CrossRef

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310. https://doi.org/10.1016/S1470-2045(14)70460-7CrossRefPubMedPubMedCentral

Roberts A, Nofech-Mozes S, Youngson B, McCready DR, Al-Assi M, Ramkumar S et al (2015) The importance of applying ACOSOG Z0011 criteria in the axillary management of invasive lobular carcinoma: a multi-institutional cohort study. Ann Surg Oncol 22:3397–3401. https://doi.org/10.1245/s10434-015-4756-0CrossRefPubMed

Sledge GW, Chagpar A, Perou C (2016) Collective wisdom: lobular carcinoma of the breast. Am Soc Clin Oncol Educ B 35:18–21. https://doi.org/10.14694/edbk_100002CrossRef

Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KGA et al (2010) The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Cancer Res Treat 119:415–422. https://doi.org/10.1007/s10549-009-0616-6CrossRef

Mamtani A, Zabor EC, Stempel M, Morrow M (2019) Lobular histology does not predict the need for axillary dissection among ACOSOG Z0011-eligible breast cancers. Ann Surg Oncol 26:3269–3274. https://doi.org/10.1245/s10434-019-07536-zCrossRefPubMed

Mamtani A, King TA (2018) Lobular breast cancer: different disease, different algorithms? Surg Oncol Clin N Am 27:81–94. https://doi.org/10.1016/j.soc.2017.07.005CrossRefPubMed

Mukhtar RA, Wong J, Piper M, Zhu Z, Fahrner-Scott K, Mamounas M et al (2018) Breast conservation and negative margins in invasive lobular carcinoma: the impact of oncoplastic surgery and shave margins in 358 patients. Ann Surg Oncol 25:3165–3170. https://doi.org/10.1245/s10434-018-6682-4CrossRefPubMed

Wei S, Bleiweiss IJ, Nagi C, Jaffer S (2014) Characteristics of breast carcinoma cases with false-negative sentinel lymph nodes. Clin Breast Cancer 14:280–284. https://doi.org/10.1016/j.clbc.2013.12.009CrossRefPubMed

10.

Johnson K, Sarma D, Hwang ES (2015) Lobular breast cancer series: Imaging. Breast Cancer Res 17:94. https://doi.org/10.1186/s13058-015-0605-0CrossRefPubMedPubMedCentral

11.

Caudle AS, Hunt KK, Tucker SL, Hoffman K, Gainer SM, Lucci A et al (2012) American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol 19:3144–3151. https://doi.org/10.1245/s10434-012-2531-zCrossRefPubMedPubMedCentral

12.

Poodt IGM, Spronk PER, Vugts G, van Dalen T, Vrancken Peeters MTFD, Rots ML et al (2017) Trends on axillary surgery in nondistant metastatic breast cancer patients treated between 2011 and 2015: a Dutch population-based study in the ACOSOG-Z0011 and AMAROS era. Ann Surg 268:1084–1090. https://doi.org/10.1097/SLA.0000000000002440CrossRef

13.

Wang J, Mittendorf EA, Sahin AA, Yi M, Caudle A, Hunt KK et al (2014) Outcomes of sentinel lymph node dissection alone vs. axillary lymph node dissection in early stage invasive lobular carcinoma: A retrospective study of the Surveillance, Epidemiology and End Results (SEER) database. PLoS ONE 9:1–7. https://doi.org/10.1371/journal.pone.0089778CrossRef

14.

Singletary SE, Patel-Parekh L, Bland KI (2005) Treatment trends in early-stage invasive lobular carcinoma: a report from the National Cancer Data Base. Ann Surg 242:281–289. https://doi.org/10.1097/01.sla.0000171306.74366.22CrossRefPubMedPubMedCentral

15.

Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK et al (2017) AJCC cancer staging manual, 8th edn. Springer, New York. https://doi.org/10.1007/978-3-319-40618-3CrossRef

16.

Royston P (2001) Flexible parametric alternatives to the Cox model, and more. Stata J 1:1–28CrossRef

17.

Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347:567–575. https://doi.org/10.1056/NEJMoa020128CrossRefPubMed

18.

Park TS, Thomas SM, Rosenberger LH, Fayanju OM, Plichta JK, Blitzblau RC et al (2018) The association of extent of axillary surgery and survival in women with N2–3 invasive breast cancer. Ann Surg Oncol 25:3019–3029. https://doi.org/10.1245/s10434-018-6587-2CrossRefPubMedPubMedCentral

19.

Morrow M, Giuliano AE (2011) To cut is to cure: can we really apply Z11 in practice? Ann Surg Oncol 18:2413–2415. https://doi.org/10.1245/s10434-011-1857-2CrossRefPubMed

20.

Gebhardt BJ, Thomas J, Horne ZD, Champ CE, Farrugia DJ, Diego E et al (2018) Is completion axillary lymph node dissection necessary in patients who are underrepresented in the ACOSOG Z0011 trial? Adv Radiat Oncol 3:258–264. https://doi.org/10.1016/j.adro.2018.03.004CrossRefPubMedPubMedCentral

21.

Yun JH, Diaz R, Orman AG (2018) Breast reconstruction and radiation therapy. Cancer Control. https://doi.org/10.1177/1073274818795489CrossRefPubMedPubMedCentral

Titel: Evaluating the impact of axillary dissection on recurrence-free survival by extent of nodal disease in invasive lobular carcinoma of the breast
verfasst von: Mary Kathryn Abel
Kelly Fahrner-Scott
Jasmine Wong
Michael Alvarado
Cheryl Ewing
Laura J. Esserman
Catherine Park
Rita A. Mukhtar
Publikationsdatum: 21.07.2020
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 3/2020
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05794-0

Springer Medizin

Evaluating the impact of axillary dissection on recurrence-free survival by extent of nodal disease in invasive lobular carcinoma of the breast