The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer

Ingrid G. M. Poodt; Robert-Jan Schipper; Guusje Vugts; Karlijn Woensdregt; Maurice van der Sangen; Adri C. Voogd; Grard A. P. Nieuwenhuijzen

doi:10.1016/j.ejso.2018.07.005

The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer

Ingrid G. M. Poodt^*, Robert-Jan Schipper, Guusje Vugts, Karlijn Woensdregt, Maurice van der Sangen, Adri C. Voogd, Grard A. P. Nieuwenhuijzen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated.

Methods: A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival.

Results: In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging.

Conclusion: This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with >= 2 comorbidities, with no apparent impact on regional control and 10-year overall survival. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Original language	English
Pages (from-to)	1714-1719
Number of pages	6
Journal	European Journal of Surgical Oncology
Volume	44
Issue number	11
DOIs	https://doi.org/10.1016/j.ejso.2018.07.005
Publication status	Published - Nov 2018

Keywords

Axillary staging
Breast cancer
Elderly women
NON-INFERIORITY TRIAL
LYMPH-NODE BIOPSY
INTERNATIONAL SOCIETY
GERIATRIC ONCOLOGY
DECISION-MAKING
OLDER PATIENTS
SENTINEL NODE
FOLLOW-UP
SURGERY
DISSECTION

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10.1016/j.ejso.2018.07.005

Cite this

@article{fbd71879141a477ea62787687bf32460,

title = "The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer",

abstract = "Background: The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called {"}incomplete staging{"}. Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated.Methods: A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival.Results: In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging.Conclusion: This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with >= 2 comorbidities, with no apparent impact on regional control and 10-year overall survival. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.",

keywords = "Axillary staging, Breast cancer, Elderly women, NON-INFERIORITY TRIAL, LYMPH-NODE BIOPSY, INTERNATIONAL SOCIETY, GERIATRIC ONCOLOGY, DECISION-MAKING, OLDER PATIENTS, SENTINEL NODE, FOLLOW-UP, SURGERY, DISSECTION",

author = "Poodt, {Ingrid G. M.} and Robert-Jan Schipper and Guusje Vugts and Karlijn Woensdregt and {van der Sangen}, Maurice and Voogd, {Adri C.} and Nieuwenhuijzen, {Grard A. P.}",

year = "2018",

month = nov,

doi = "10.1016/j.ejso.2018.07.005",

language = "English",

volume = "44",

pages = "1714--1719",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "ELSEVIER SCI LTD",

number = "11",

}

TY - JOUR

T1 - The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer

AU - Poodt, Ingrid G. M.

AU - Schipper, Robert-Jan

AU - Vugts, Guusje

AU - Woensdregt, Karlijn

AU - van der Sangen, Maurice

AU - Voogd, Adri C.

AU - Nieuwenhuijzen, Grard A. P.

PY - 2018/11

Y1 - 2018/11

N2 - Background: The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated.Methods: A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival.Results: In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging.Conclusion: This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with >= 2 comorbidities, with no apparent impact on regional control and 10-year overall survival. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

AB - Background: The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated.Methods: A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival.Results: In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging.Conclusion: This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with >= 2 comorbidities, with no apparent impact on regional control and 10-year overall survival. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

KW - Axillary staging

KW - Breast cancer

KW - Elderly women

KW - NON-INFERIORITY TRIAL

KW - LYMPH-NODE BIOPSY

KW - INTERNATIONAL SOCIETY

KW - GERIATRIC ONCOLOGY

KW - DECISION-MAKING

KW - OLDER PATIENTS

KW - SENTINEL NODE

KW - FOLLOW-UP

KW - SURGERY

KW - DISSECTION

U2 - 10.1016/j.ejso.2018.07.005

DO - 10.1016/j.ejso.2018.07.005

M3 - Article

C2 - 30082177

SN - 0748-7983

VL - 44

SP - 1714

EP - 1719

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 11

ER -