Abstract
The Z0011 trial initiated a paradigm shift in the axillary treatment of breast cancer patients with a positive sentinel lymph node biopsy (SLNB), disregarding patients with a positive ultrasound-guided lymph node biopsy (UGLNB). We examined whether relevant differences exist between these patients to determine if the conclusions of the ACOSOG Z0011 trial are applicable to UGLNB-positive patients.
Patients diagnosed with invasive breast cancer in the Netherlands between January 2008 and December 2014 were selected from the Netherlands Cancer Registry.
A total of 11,820 cases were included: 9149 cases in the SLNB group and 2671 in the UGLNB group. Multivariate analyses showed that UGLNB-positive patients were older (p <0.001), more likely to have a poorly differentiated tumor (p <0.001), had a negative hormone receptor status (p <0.001), and more often had extensive nodal involvement (p <0.001). However, they were less likely to undergo adjuvant radiation (p = 0.004) or systemic therapy (p <0.001). Even after adjusting for these factors, UGLNB-positive patients had a worse overall survival (HR = 1.38; 95% CI 1.23-1.56) than SLNB-positive patients.
This nationwide retrospective study shows that young patients found positive by UGLNB have less favorable disease characteristics and a worse prognosis compared to patients with a positive SLNB. Selection by ultrasound plays an important role when axillary treatment strategies are considered. Hence, the conclusions of the Z0011 trial cannot unconditionally be applied to patients with a positive UGLNB.
Original language | English |
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Pages (from-to) | 555-563 |
Number of pages | 9 |
Journal | Breast Cancer Research and Treatment |
Volume | 165 |
Issue number | 3 |
DOIs | |
Publication status | Published - Oct 2017 |
Keywords
- Ultrasound
- Sentinel node
- Breast cancer
- Survival
- ACOSOG Z0011 TRIAL
- AMERICAN-COLLEGE
- CLINICAL-PRACTICE
- LYMPH-NODES
- SURGEONS
- DISSECTION
- METASTASES
- BIOPSY
- IMPACT
- INVOLVEMENT