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The Exportability of the ACOSOG Z0011 Criteria for Omitting Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy Findings: A Multicenter Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To determine the exportability of the criteria defined by the American College of Surgeons Oncology Group Z0011 trial for selecting patients who are eligible for omitting completion axillary lymph node dissection (cALND) after a positive sentinel lymph node (SLN) biopsy result and to investigate whether not following the Z0011 criteria might affect patient outcomes.

Methods

From a multicenter database, we selected 188 patients with positive SLNs and then excluded patients with positive SLNs on immunohistochemistry only. We retrospectively applied the Z0011 criteria and grouped the patients as eligible or ineligible for omitting cALND. The eligible group was compared with the cohort included in the Z0011 trial and with the ineligible group. Kaplan–Meier survival curves were calculated for each group, and univariate analyses assessed associations between the groups and clinicopathological variables.

Results

The final analysis involved 125 patients with positive SLNs. Eighty-seven patients (69.6 %) were potentially eligible for omitting cALND. The estrogen receptor status, T stage, grade, and number of positive non-SLNs were not statistically different between the eligible group and the Z0011 cohort. The ineligible group had significantly more positive non-SLNs (P = 0.01) and a lower 5-year overall survival rate than the eligible group (P < 0.001).

Conclusions

The similarity of clinical characteristics between the Z0011 trial cohort and our eligible group confirms the exportability of these criteria to another population. The worse prognosis of patients who did not meet the Z0011 criteria suggests prudence before disregarding or enlarging broadening the indications for omitting cALND.

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References

  1. National Comprehensive Cancer Network (NCCN). Clinical pratices guidelines in oncology: breast cancer, version 2.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed August 20, 2012.

  2. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.

    Article  PubMed  CAS  Google Scholar 

  3. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.

    PubMed  Google Scholar 

  4. Caudle AS, Hunt KK, Kuerer HM, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;18:2407–12.

    Article  PubMed  Google Scholar 

  5. Kumar A, Puri R, Gadgil PV, Jatoi I. Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg. 2012;36:1453–9.

    Article  PubMed  Google Scholar 

  6. Gainer SM, Hunt KK, Beitsch P, Caudle AS, Mittendorf EA, Lucci A. Changing behavior in clinical practice in response to the ACOSOG Z0011 trial: a survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2012;19:3152–8.

    Article  PubMed  Google Scholar 

  7. Guth U, Myrick ME, Viehl CT, Schmid SM, Obermann EC, Weber WP. The post ACOSOG Z0011 era: does our new understanding of breast cancer really change clinical practice? Eur J Surg Oncol. 2012;38:645–50.

    Article  PubMed  CAS  Google Scholar 

  8. Caudle AS, Hunt KK, Tucker SL, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19:3144–51.

    Article  PubMed  Google Scholar 

  9. Cody HS 3rd. Does the rapid acceptance of ACOSOG Z0011 compromise selection of systemic therapy? Ann Surg Oncol. 2012;19:3643–5.

    Article  PubMed  Google Scholar 

  10. Feldman SM, Sweatman CA Jr. Sentinel node biopsy for breast cancer: past, present, and future (editorial). Ann Surg Oncol. 2012;19:3123–4.

    Article  PubMed  Google Scholar 

  11. Haffty BG, Hunt KK, Harris JR, Buchholz TA. Positive sentinel nodes without axillary dissection: implications for the radiation oncologist. J Clin Oncol. 2011;29:4479–81.

    Article  PubMed  Google Scholar 

  12. Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657–63.

    Article  PubMed  Google Scholar 

  13. Dabakuyo TS, Fraisse J, Causeret S, et al. A multicenter cohort study to compare quality of life in breast cancer patients according to sentinel lymph node biopsy or axillary lymph node dissection. Ann Oncol. 2009;20:1352–61.

    Article  PubMed  CAS  Google Scholar 

  14. Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ. Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol. 2010;17:3278–86.

    Article  PubMed  Google Scholar 

  15. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26:5213–9.

    Article  PubMed  Google Scholar 

  16. Jatoi I. Axillary vs sentinel lymph node dissection for invasive breast cancer. JAMA. 2011;305:2288.

    Article  PubMed  CAS  Google Scholar 

  17. Yi M, Mittendorf EA, Cormier JN, et al. Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system. J Clin Oncol. 2011;29:4654–61.

    Article  PubMed  Google Scholar 

  18. Galimberti V, Cole B, Zurrida S, et al. Update of International Breast Cancer Study Group Trial 23-01 to compare axillary dissection versus no axillary dissection in patients with clinically node negative breast cancer and micrometastases in the sentinel node (abstract). Cancer Res. 2011;71(24 Suppl.):S3–1.

    Google Scholar 

  19. Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non–sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004;91:1245–52.

    Article  PubMed  CAS  Google Scholar 

  20. Rescigno J, Zampell JC, Axelrod D. Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy. Ann Surg Oncol. 2009;16:687–96.

    Article  PubMed  Google Scholar 

  21. Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27:2946–53.

    Article  PubMed  Google Scholar 

  22. Pepels MJ, de Boer M, Bult P, et al. Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells. Ann Surg. 2012;255:116–21.

    Article  PubMed  Google Scholar 

  23. Setton J, Cody H, Tan L, et al. Radiation field design and regional control in sentinel lymph node–positive breast cancer patients with omission of axillary dissection. Cancer. 2012;118:1994–2003.

    Article  PubMed  Google Scholar 

  24. Milgrom S, Cody H, Tan L, et al. Characteristics and outcomes of sentinel node–positive breast cancer patients after total mastectomy without axillary-specific treatment. Ann Surg Oncol. 2012;19:3762–70.

    Article  PubMed  Google Scholar 

  25. Coutant C, Olivier C, Lambaudie E, et al. Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study. J Clin Oncol. 2009;27:2800–8.

    Article  PubMed  Google Scholar 

  26. Lannin DR, Killelea B, Horowitz N, Chagpar AB. Validation of the Louisville breast sentinel node prediction models and a proposed modification to guide management of the node positive axilla. Am Surg. 2012;78:761–5.

    PubMed  Google Scholar 

  27. Hiotis K, Ye W, Sposto R, Goldberg J, Mukhi V, Skinner K. The importance of location in determining breast conservation rates. Am J Surg. 2005;190:18–22.

    Article  PubMed  Google Scholar 

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Acknowledgment

Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yann Delpech MD

  2. Department of Gynecology and Obstetrics, Lariboisiere Hospital/AP-HP, The University Denis Diderot, Paris, France

    Yann Delpech MD, Ruben Lousquy MD, Anne Thoury MD & Emmanuel Barranger MD

  3. Department of Gynecology and Obstetrics, Jean Verdier Hospital/AP-HP, The University Paris Nord, Bondy, France

    Alexandre Bricou MD & Claire Willecocq MD

  4. Department of Surgical Oncology, Georges Francois Leclerc Cancer Center, The University of Bourgogne, Dijon, France

    Delphine Hudry MD, Clémentine Jankowski MD, Catherine Loustalot MD & Charles Coutant MD, PhD

Authors
  1. Yann Delpech MD
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  2. Alexandre Bricou MD
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  9. Charles Coutant MD, PhD
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  10. Emmanuel Barranger MD
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Correspondence to Yann Delpech MD.

Additional information

Charles Coutant and Emmanuel Barranger contributed equally to this article, and both should be considered senior author.

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Delpech, Y., Bricou, A., Lousquy, R. et al. The Exportability of the ACOSOG Z0011 Criteria for Omitting Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy Findings: A Multicenter Study. Ann Surg Oncol 20, 2556–2561 (2013). https://doi.org/10.1245/s10434-013-2917-6

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  • DOI: https://doi.org/10.1245/s10434-013-2917-6

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