Surgical Management of the Axilla in Elderly Women With Node-Positive Breast Cancer

被引:11
|
作者
Marks, Caitlin E. [1 ]
Thomas, Samantha M. [2 ,3 ]
Greenup, Rachel A. [1 ,2 ]
Fayanju, Oluwadamilola M. [1 ,2 ,4 ]
McDuff, Susan [2 ,5 ]
Kimmick, Gretchen [2 ,6 ]
Hwang, E. Shelley [1 ,2 ]
Plichta, Jennifer K. [1 ,2 ]
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
[2] Duke Canc Inst, Durham, NC USA
[3] Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA
[4] Durham VA Med Ctr, Dept Surg, Durham, NC USA
[5] Duke Univ, Med Ctr, Dept Radiat Oncol, Durham, NC USA
[6] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
关键词
Elderly; Breast cancer; Node-positive; Axillary lymph node dissection; OLDER WOMEN; SENTINEL NODE; DISSECTION; ONCOLOGY; SURVIVAL; SURGERY; RADIOTHERAPY; INVOLVEMENT; THERAPY; SOCIETY;
D O I
10.1016/j.jss.2020.04.036
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women with node-positive BC was associated with overall survival (OS). Methods: Using the National Cancer Database (2010-2015), women 70-90 y with cN + BC and >= 1 LNs removed were categorized by treatment sequence: upfront surgery or neoadjuvant chemotherapy (NAC). Multivariable Cox proportional hazards models with restricted cubic splines characterized the functional association of LN retrieval with OS; threshold values of LN retrieval were estimated. Cox proportional hazards models were used to estimate the association of LN retrieval groups with OS. Results: In the upfront surgery cohort, a nonlinear association was identified between LNs retrieved and OS. In the NAC cohort, no association was identified. For the upfront surgery cohort, the optimal threshold value of LN retrieval was 21 LNs (90% confidence interval 1823). Based on this estimate, LN retrieval groups were created: 6, 6-11, 12-17, 18-23, and 23 LNs. After adjustment, retrieval of <12 LNs in the upfront surgery group was associated with a worse OS. No differences were observed in the NAC group. Conclusions: For elderly women receiving upfront surgery, there is no survival benefit to removing more than 12 LNs, and for those receiving NAC, there is no association between number of LNs removed and survival. In older women who present with cN + BC, aggressive surgery to remove more than 12 LNs may not be necessary. (c) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:275 / 285
页数:11
相关论文
共 50 条
  • [21] Predictive factors of an axillary pathological complete response of node-positive breast cancer to neoadjuvant chemotherapy
    Iwamoto, Naoko
    Aruga, Tomoyuki
    Horiguchi, Shinichiro
    Saita, Chiaki
    Onishi, Mai
    Goto, Risa
    Ishiba, Toshiyuki
    Honda, Yayoi
    Miyamoto, Hiromi
    Kuroi, Katsumasa
    SURGERY TODAY, 2020, 50 (02) : 178 - 184
  • [22] Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses
    Schmidt-Hansen, Mia
    Bromham, Nathan
    Hasler, Elise
    Reed, Malcolm W.
    SPRINGERPLUS, 2016, 5 : 1 - 13
  • [23] Treatment of sentinel node-positive breast cancer
    Chagpar, Anees B.
    McMasters, Kelly M.
    EXPERT REVIEW OF ANTICANCER THERAPY, 2006, 6 (08) : 1233 - 1239
  • [24] Original Article Clinical Experience of Axillary Radiotherapy for Node-positive Breast Cancer
    Anderson, S.
    Peters, A. L.
    Lumsden, G.
    Alhasso, A.
    Cartwright, D.
    Marashi, H.
    Beatson, Marashi
    CLINICAL ONCOLOGY, 2024, 36 (02) : 98 - 106
  • [25] The involvement of axillary reverse mapping nodes in patients with node-positive breast cancer
    Noguchi, Masakuni
    Inokuchi, Masafumi
    Yokoi-Noguchi, Miki
    Morioka, Emi
    Haba, Yusuke
    EJSO, 2023, 49 (10):
  • [26] Targeting and limiting surgery for patients with node-positive breast cancer
    Caudle, Abigail S.
    Kuerer, Henry M.
    BMC MEDICINE, 2015, 13
  • [27] Nomogram for prediction of level 2 axillary lymph node metastasis in proven level 1 node-positive breast cancer patients
    Jiang, Yanlin
    Xu, Hong
    Zhang, Hao
    Ou, Xunyan
    Xu, Zhen
    Ai, Liping
    Sun, Lisha
    Liu, Caigang
    ONCOTARGET, 2017, 8 (42) : 72389 - 72399
  • [28] Selective Axillary Node Sampling and Radiotherapy to the Axilla in the Management of Breast Cancer
    Tanguay, J. S.
    Ford, D. R.
    Sadler, G.
    Buckley, L.
    Uppal, H.
    Cross, J.
    Holmes, N.
    Mayer, K. Fortes
    Fernando, I.
    CLINICAL ONCOLOGY, 2008, 20 (09) : 677 - 682
  • [29] The management concept of breast cancer with clinically node-negative/imaging node-positive disease
    Bi, Zhao
    Ren, Tong-Yue
    Zhang, Zhao-Peng
    Wang, Yong-Sheng
    INTERNATIONAL JOURNAL OF SURGERY, 2023, 109 (11) : 3727 - 3729
  • [30] The number of positive nodes and the ratio of positive to excised nodes are significant predictors of survival in women with micrometastatic node-positive breast cancer
    Truong, Pauline T.
    Vinh-Hung, Vincent
    Cserni, Gabor
    Woodward, Wendy A.
    Tai, Patricia
    Vlastos, Georges
    EUROPEAN JOURNAL OF CANCER, 2008, 44 (12) : 1670 - 1677