Changes in Surgical Management of the Axilla Over 11 Years - Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial

被引：26

作者：

Boughey, Judy C. ^{[1
]}

Yu, Hongmei ^{[2
]}

Dugan, Catherine Lu ^{[3
]}

Piltin, Mara A. ^{[1
]}

Postlewait, Lauren ^{[4
]}

Son, Jennifer D. ^{[5
]}

Edmiston, Kirsten K. ^{[6
]}

Godellas, Constantine V. ^{[7
]}

Lee, Marie C. ^{[8
]}

Carr, Michael J. ^{[9
]}

Tonneson, Jennifer E. ^{[10
]}

Crown, Angelena ^{[11
]}

Lancaster, Rachel B. ^{[12
]}

Woriax, Hannah E. ^{[13
]}

Ewing, Cheryl A. ^{[14
]}

Chau, Harrison S. ^{[15
]}

Patterson, Anne K. ^{[16
]}

Wong, Jasmine M. ^{[16
]}

Alvarado, Michael D. ^{[16
]}

Yang, Rachel L. ^{[17
]}

Chan, Theresa W. ^{[18
]}

Sheade, Jori B. ^{[19
]}

Ahrendt, Gretchen M. ^{[20
]}

Larson, Kelsey E. ^{[21
]}

Switalla, Kayla ^{[22
]}

Tuttle, Todd M. ^{[22
]}

Tchou, Julia C. ^{[23
]}

Rao, Roshni ^{[24
]}

Tamirisa, Nina ^{[25
]}

Singh, Puneet ^{[26
]}

Gould, Rebekah E. ^{[27
]}

Terando, Alicia ^{[28
]}

Sauder, Candice ^{[29
]}

Hewitt, Kelly ^{[30
]}

Chiba, Akiko ^{[31
]}

Esserman, Laura J. ^{[32
,33
]}

Mukhtar, Rita A. ^{[32
]}

机构：

[1] Mayo Clin, Dept Surg, Div Breast & Melanoma Surg Oncol, Rochester, MN 55905 USA

[2] Quantum Leap Healthcare Collaborat, San Francisco, CA USA

[3] UCSF Hlth, Breast Care Ctr, San Francisco, CA USA

[4] Emory Univ, Dept Surg, Div Surg Oncol, Sch Med, Atlanta, GA USA

[5] MedStar Georgetown Univ, Ourisman Breast Ctr, Washington, DC USA

[6] Univ Virginia, Dept Surg, Inova Campus, Fairfax, VA USA

[7] Loyola Univ, Dept Surg, Med Ctr, Maywood, IL USA

[8] H Lee Moffitt Canc Ctr & Res Inst, Div Breast Oncol, Tampa, FL USA

[9] H Lee Moffitt Canc Ctr & Res Inst, Dept Breast Surg, Tampa, FL USA

[10] Oregon Hlth & Sci Univ, Div Surg Oncol, Portland, OR USA

[11] Swedish Canc Inst, True Family Womens Canc Ctr, Seattle, WA USA

[12] Univ Alabama Birmingham, Div Surg Oncol, Med Ctr, Birmingham, AL USA

[13] Duke Univ, Div Surg Oncol, Sch Med, Durham, NC USA

[14] Univ Calif San Francisco, Div Surg Oncol, San Francisco, CA USA

[15] Univ Calif San Diego, Dept Surg, La Jolla, CA USA

[16] Univ Calif San Francisco, Dept Surg, Div Surg Oncol, San Francisco, CA USA

[17] Stanford Hosp & Clin, Dept Surg, Stanford, CA USA

[18] Ironwood Canc & Res Ctr, Dept Breast Surg Oncol, Scottsdale, AZ USA

[19] Univ Chicago, Div Hematol & Oncol, Chicago, IL USA

[20] Univ Colorado Denver, Div Surg Oncol, Anschutz Med Campus, Boulder, CO USA

[21] Univ Kansas, Dept Surg, Canc Ctr, Kansas City, KS USA

[22] Univ Minnesota, Dept Surg, Minneapolis, MN USA

[23] Univ Penn, Dept Breast Surg Res, Penn Med, Philadelphia, PA USA

[24] Columbia Univ, Div Breast Surg, Vagelos Coll Phys & Surg, New York, NY USA

[25] Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX USA

[26] Univ Texas MD Anderson Canc Ctr Houston, Dept Breast Surg Oncol, Div Surg, Houston, TX USA

[27] Univ Texas MD Anderson Canc Ctr Houston, Dept Translat Mol Pathol, Houston, TX USA

[28] Cedars Sinai Canc, Dept Surg, Div Surg Oncol, Huntington Canc Ctr, Pasadena, CA USA

[29] UC Davis Hlth, Dept Surg, Comprehens Canc Ctr, Sacramento, CA USA

[30] Vanderbilt Univ, Dept Surg, Div Surg Oncol & Endocrine Surg, Med Ctr, Nashville, TN USA

[31] Duke Univ, Dept Surg, Med Ctr, Durham, NC USA

[32] UCSF, Dept Surg, San Francisco, CA USA

[33] UCSF, Dept Radiol, San Francisco, CA USA

来源：

ANNALS OF SURGICAL ONCOLOGY | 2023年 / 30卷 / 11期

基金：

美国国家卫生研究院;

关键词：

Sentinel lymph node surgery; Axillary dissection; Neoadjuvant chemotherapy; LYMPH-NODE BIOPSY; SENTINEL NODE; ADAPTIVE RANDOMIZATION; DISSECTION; LYMPHADENECTOMY; ACCURATE; SURGERY;

D O I：

10.1245/s10434-023-13759-y

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BackgroundAxillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial.MethodsWe examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time.ResultsOf 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR-/HER2-, HR+/HER2-, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001).ConclusionsUse of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.

引用

页码：6401 / 6410

页数：10

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