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American College of Surgeons Oncology Group (ACOSOG) Z0011: Impact on Surgeon Practice Patterns

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

Abstract

Introduction

The ACOSOG Z0011 trial has been described as practice-changing. The goal of this study was to determine the impact of the trial on surgeon practice patterns at our institution.

Methods

This is a review of practice patterns comparing the year before release of Z0011 to the year after an institutional multidisciplinary meeting discussing the results. Patients meeting Z0011 inclusion criteria were identified. Clinicopathologic data were compared between the cohorts.

Results

There were 658 patients with clinical T1-2 tumors planned for breast conservation: 335 in the pre-Z0011 cohort and 323 post-Z0011. Sixty-two (19 %) patients were sentinel lymph node (SLN) positive in the pre-Z0011 group versus 42 (13 %) post-Z0011 (p = 0.06). Before Z0011, 85 % (53/62) of SLN-positive patients underwent axillary node dissection (ALND) versus 24 % (10/42) after Z0011 (p < 0.001). After Z0011, surgeons were more likely to perform ALND on patients with larger tumors (2.2 vs. 1.5 cm, p = 0.09), lobular histology (p = 0.01), fewer SLNs (1 vs. 3, p = 0.09), larger SLN metastasis size (4 vs. 2.5 mm, p = 0.19), extranodal extension present (20 vs. 6 %, p = 0.16), or a higher probability of positive non-SLNs (p = 0.03). Surgeons were less likely to perform intraoperative nodal assessment post-Z0011 (26 vs. 69 %, p < 0.001) resulting in decreased median operative times for SLN-negative patients (79 vs. 92 min, p < 0.001).

Conclusions

Surgeons at our institution have implemented Z0011 results for the majority of patients; however, clinicopathologic factors still impact the decision to perform ALND. Z0011 results have significantly impacted practice by decreasing rates of ALND, use of intraoperative nodal evaluation, and operative times.

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Authors and Affiliations

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

    Abigail S. Caudle MD, Kelly K. Hunt MD, Sarah M. Gainer MD, Anthony Lucci MD, Henry M. Kuerer MD, Funda Meric-Bernstam MD, Ruchita Shah BS, Gildy V. Babiera MD & Elizabeth A. Mittendorf MD

  2. Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Susan L. Tucker PhD

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Karen Hoffman MD

  4. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aysegul A. Sahin MD

Authors
  1. Abigail S. Caudle MD
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  2. Kelly K. Hunt MD
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  3. Susan L. Tucker PhD
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  4. Karen Hoffman MD
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  5. Sarah M. Gainer MD
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  6. Anthony Lucci MD
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  7. Henry M. Kuerer MD
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  8. Funda Meric-Bernstam MD
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  9. Ruchita Shah BS
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  10. Gildy V. Babiera MD
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  11. Aysegul A. Sahin MD
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  12. Elizabeth A. Mittendorf MD
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Corresponding authors

Correspondence to Abigail S. Caudle MD or Elizabeth A. Mittendorf MD.

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Caudle, A.S., Hunt, K.K., Tucker, S.L. et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: Impact on Surgeon Practice Patterns. Ann Surg Oncol 19, 3144–3151 (2012). https://doi.org/10.1245/s10434-012-2531-z

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  • DOI: https://doi.org/10.1245/s10434-012-2531-z

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