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] Surgical management of the positive sentinel lymph node in elderly breast cancer patients.
    Gemignani, ML
    Giron, GL
    Fey, J
    Montgomery, LL
    Sachini, V
    Sclafani, L
    Heerdt, A
    Borgen, PI
    Van Zee, K
    Cody, H
    JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (14) : 94S - 94S
  • [22] Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer
    Bellefqih, Sara
    Elmajjaoui, Sanaa
    Aarab, Jihan
    Khalil, Jihane
    Afif, Mohamed
    Lachgar, Amine
    El Kacemi, Hanan
    Kebdani, Tayeb
    Benjaafar, Noureddine
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2017, 97 (03): : 563 - 570
  • [23] No nodal cutoff in node-positive breast cancer women treated with mastectomy
    Vinh-Hung, V.
    Storme, G.
    BREAST CANCER RESEARCH AND TREATMENT, 2006, 98 (02) : 173 - 178
  • [24] Management of the axilla in women with breast cancer
    Benson, John R.
    della Rovere, G. Querci
    LANCET ONCOLOGY, 2007, 8 (04): : 331 - 348
  • [25] Management of the axilla in women with breast cancer
    Benson, J. R.
    della Rovere, G. Querci
    BREAST, 2007, 16 (02): : 130 - 136
  • [26] Management of Early Node-Positive Breast Cancer in Australia: A Multicentre Study
    Gannan, Emma
    Khoo, Jeremy
    Nightingale, Sophie
    Suhardja, Thomas Surya
    Lippey, Jocelyn
    Keane, Holly
    Tan, Kian Jin
    Clouston, David
    Gorelik, Alexandra
    Mann, Gregory Bruce
    BREAST JOURNAL, 2016, 22 (04): : 413 - 419
  • [27] Treatment of sentinel node-positive breast cancer
    Chagpar, Anees B.
    McMasters, Kelly M.
    EXPERT REVIEW OF ANTICANCER THERAPY, 2006, 6 (08) : 1233 - 1239
  • [28] Adjuvant docetaxel for node-positive breast cancer
    Noronha, V
    NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (09): : 954 - 954
  • [29] Axillary surgery in node-positive breast cancer
    Weber, W.
    BREAST, 2021, 56 : S7 - S7
  • [30] Axillary surgery in node-positive breast cancer
    Maggi, Nadia
    Nussbaumer, Rahel
    Holzer, Liezl
    Weber, Walter P.
    BREAST, 2022, 62 : S50 - S53