Skip to main content

Advertisement

SpringerLink
Log in

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

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

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

The role of completion axillary lymph node dissection (ALND) for older women who had sentinel lymph node-positive (SLN+) invasive breast cancer is unclear. We examined factors predictive of ALND and the association between ALND, adjuvant chemotherapy administration, and survival.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we reviewed records of women age >65 diagnosed with stage I/II breast cancer from 1998–2005. Adjusted Cox proportional hazards and multivariate logistic regression were used to identify patient and disease variables associated with ALND, and assess association between ALND and all-cause and breast cancer-specific survival.

Results

Among SLN+ patients, 88 % underwent ALND. Earlier diagnosis year, greater nodal involvement, younger age, registry location, and larger tumor size were all associated with a significantly higher likelihood of ALND. The ALND in SLN+ patients was not significantly associated with 5-year breast cancer-specific survival (hazard ratio [HR] 1.22, 95 % confidence interval [CI] 0.76–1.96). The SLN+ patients who underwent ALND were more likely to receive adjuvant chemotherapy (odds ratio [OR] 1.8, 95 % CI 1.45–2.24). However, younger age (OR 18.0, 95 % CI 14.4–23.9), estrogen receptor-negative (ER-) status (OR 4.2, 95 % CI 3.4–5.3), and fewer comorbidities (OR 2.6, 95 % CI 1.7–4.0) were all more strongly linked to receipt of chemotherapy.

Conclusions

ALND for older patients with SLN+ breast cancer is not associated with improved 5-year all-cause or breast cancer-specific survival. Younger age, fewer comorbidities, and estrogen receptor-negative (ER-) status were more strongly associated with receipt of chemotherapy than ALND. Consideration should be given to omitting ALND in older patients, particularly if findings of ALND will not influence adjuvant therapy decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. MMWR. From the Centers for Disease Control and Prevention Public Health and aging: trends in aging—United States and worldwide. JAMA. 2003;289:1371–3.

    Article  Google Scholar 

  2. Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.

    Article  CAS  PubMed  Google Scholar 

  3. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer–a multicenter validation study. N Engl J Med. 1998;339:941–6.

    Article  CAS  PubMed  Google Scholar 

  4. Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg. 1995;222:394–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.

    Article  PubMed  Google Scholar 

  6. Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.

    Article  PubMed  Google Scholar 

  7. 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  CAS  PubMed  Google Scholar 

  8. Karam AK, Hsu M, Patil S, et al. Predictors of completion axillary lymph node dissection in patients with positive sentinel lymph nodes. Ann Surg Oncol. 2009;16:1952–8.

    Article  PubMed  Google Scholar 

  9. Truong PT, Bernstein V, Wai E, et al. Age-related variations in the use of axillary dissection: a survival analysis of 8038 women with T1-T2 breast cancer. Int J Radiat Oncol Biol Phys. 2002;54:794–803.

    Article  PubMed  Google Scholar 

  10. Aziz D, Gardner S, Pritchard K, et al. Selective application of axillary node dissection in elderly women with early breast cancer. Ann Surg Oncol. 2007;14:652–9.

    Article  PubMed  Google Scholar 

  11. Reeder-Hayes KE, Bainbridge J, Meyer AM, et al. Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer. Breast Cancer Res Treat. 2011;128:863–71.

    Article  PubMed Central  PubMed  Google Scholar 

  12. 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 

  13. Maggard MA, Lane KE, O’Connell JB, et al. Beyond the clinical trials: how often is sentinel lymph node dissection performed for breast cancer? Ann Surg Oncol. 2005;12:41–7.

    Article  PubMed  Google Scholar 

  14. Chen AY, Halpern MT, Schrag NM, et al. Disparities and trends in sentinel lymph node biopsy among early-stage breast cancer patients (1998–2005). J Natl Cancer Inst. 2008;100:462–74.

    Article  PubMed  Google Scholar 

  15. Halpern MT, Chen AY, Marlow NS, et al. Disparities in receipt of lymph node biopsy among early-stage female breast cancer patients. Ann Surg Oncol. 2009;16:562–70.

    Article  PubMed  Google Scholar 

  16. Edge SB, Gold K, Berg CD, et al. Patient and provider characteristics that affect the use of axillary dissection in older women with stage I-II breast carcinoma. Outcomes and Preferences for Treatment in Older Women Nationwide Study Research Team. Cancer. 2002;94:2534–41.

    Article  PubMed  Google Scholar 

  17. Warren JL, Klabunde CN, Schrag D, et al. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV-3–18.

    Google Scholar 

  18. Enger SM, Thwin SS, Buist DS, et al. Breast cancer treatment of older women in integrated health care settings. J Clin Oncol. 2006;24:4377–83.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ballard-Barbash R, Potosky AL, Harlan LC, et al. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst. 1996;88:716–26.

    Article  CAS  PubMed  Google Scholar 

  20. Silliman RA, Troyan SL, Guadagnoli E, et al. The impact of age, marital status, and physician-patient interactions on the care of older women with breast cancer. Cancer. 1997;80:1326–34.

    Article  CAS  PubMed  Google Scholar 

  21. Hebert-Croteau N, Brisson J, Latreille J, et al. Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer. 1999;85:104–13.

    Article  Google Scholar 

  22. Mandelblatt JS, Hadley J, Kerner JF, et al. Patterns of breast carcinoma treatment in older women: Patient preference and clinical and physician influences. Cancer. 2000;89:561–73.

    Article  CAS  PubMed  Google Scholar 

  23. Martelli G, Boracchi P, Ardoino I, et al. Axillary dissection versus no axillary dissection in older patients with T1N0 breast cancer: 15-year results of a randomized controlled trial. Ann Surg. 2012;256:920–4.

    Article  PubMed  Google Scholar 

  24. Näslund E, Fernstad R, Ekman S, et al. Breast cancer in women over 75 years: is axillary dissection always necessary? Eur J Surg. 1996;162:867–71.

    PubMed  Google Scholar 

  25. Dees EC, Shulman LN, Souba WW, et al: Does information from axillary dissection change treatment in clinically node-negative patients with breast cancer? An algorithm for assessment of impact of axillary dissection. Ann Surg. 1997;226:279–86.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Feigelson BJ, Acosta JA, Feigelson HS, et al. T1 breast carcinoma in women 70 years of age and older may not require axillary lymph node dissection. Am J Surg. 1996;172:487–9.

    Article  CAS  PubMed  Google Scholar 

  27. Muss HB, Woolf S, Berry D, et al. Cancer and Leukemia Group B: Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 2005;293:1073–81.

    Article  CAS  PubMed  Google Scholar 

  28. Commission on Cancer National Cancer Data Base (NCDB). Coding Cancer Registry Items. 2012. http://www.facs.org/cancer/ncdb/scope-regional-lymph-node-surgery.pdf. Accessed 1 Dec 2013.

Download references

Acknowledgments

Research for this study was supported by The Safeway Foundation.

Disclosures

None

Author information

Authors and Affiliations

  1. Departments of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, USA

    Sara H. Javid MD, Hao He PhD, David R. Flum MD, MPH & Benjamin O. Anderson MD

  2. Medicine, University of Washington, Seattle, WA, USA

    Larissa A. Korde MD, MPH

Authors
  1. Sara H. Javid MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hao He PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Larissa A. Korde MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David R. Flum MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin O. Anderson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara H. Javid MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Javid, S.H., He, H., Korde, L.A. et al. Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients. Ann Surg Oncol 21, 2172–2180 (2014). https://doi.org/10.1245/s10434-014-3595-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3595-8

Keywords

Search

Navigation