LymphedemaV1, Main, Exploration, bibRecord, 004236

Impact of the ACOSOG Z0011 Criteria Applied to a Contemporary Patient Population

Identifieur interne : 004236 ( Main/Exploration ); précédent : 004235; suivant : 004237

Impact of the ACOSOG Z0011 Criteria Applied to a Contemporary Patient Population

Auteurs : Min Yi ; Henry M. Kuerer ; Elizabeth A. Mittendorf ; Rosa F. Hwang ; Abigail S. Caudle ; Isabelle Bedrosian ; Funda Meric-Bernstam ; Jamie L. Wagner ; Kelly K. Hunt

Source :

Journal of the American College of Surgeons [ 1072-7515 ] ; 2012.

RBID : PMC:4331643

Abstract

Background

The ACOSOG Z0011 trial concluded that axillary lymph node dissection (ALND) may not be necessary for all patients with sentinel lymph node (SLN) metastasis undergoing breast-conserving therapy (BCT). The aim of this study was to assess applicability of Z0011 results to our patient population and determine what percentage may be affected by these results.

Study Design

Patients with clinical T1-2,N0 breast cancer treated with surgery first between 1994 and 2009 who had 1–2 positive SLNs were included in this study. Kaplan-Meier survival curves were calculated and log-rank used to compare overall survival (OS) and disease-free survival (DFS) for ALND vs. SLN dissection (SLND) alone in two patient populations: patients undergoing BCT or total mastectomy (TM) and patients undergoing BCT only.

Results

Of 861 patients, 188 (21.8%) underwent SLND alone. Of 488 (56.7%) patients who underwent BCT, 125 (25.6%) had SLND alone. Of 412 patients undergoing TM, 67 (16.3%) had SLND alone. Patients undergoing ALND were significantly younger, had larger tumors, macrometastasis and extranodal extension in both populations. Compared with the Z0011 cohort, our BCT patients had more T1 tumors (76.0% vs 69.3%, P = .01) and more grade II–III tumors (87.3% vs 76.2%, P < .0001). After adjusting for T-stage, there were no significant differences in DFS and OS between patients undergoing SLND alone or ALND in both populations.

Conclusions

Examination of our breast cancer patients with Z0011 trial criteria suggests that almost 75% of SLN-positive patients would be candidates to avoid ALND if they undergo BCT.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331643

DOI: 10.1016/j.jamcollsurg.2012.09.005
PubMed: 23122536
PubMed Central: 4331643

Affiliations:

Le document en format XML

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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">The ACOSOG Z0011 trial concluded that axillary lymph node dissection (ALND) may not be necessary for all patients with sentinel lymph node (SLN) metastasis undergoing breast-conserving therapy (BCT). The aim of this study was to assess applicability of Z0011 results to our patient population and determine what percentage may be affected by these results.</p>
</sec>
<sec id="S2"><title>Study Design</title>
<p id="P3">Patients with clinical T1-2,N0 breast cancer treated with surgery first between 1994 and 2009 who had 1–2 positive SLNs were included in this study. Kaplan-Meier survival curves were calculated and log-rank used to compare overall survival (OS) and disease-free survival (DFS) for ALND vs. SLN dissection (SLND) alone in two patient populations: patients undergoing BCT or total mastectomy (TM) and patients undergoing BCT only.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Of 861 patients, 188 (21.8%) underwent SLND alone. Of 488 (56.7%) patients who underwent BCT, 125 (25.6%) had SLND alone. Of 412 patients undergoing TM, 67 (16.3%) had SLND alone. Patients undergoing ALND were significantly younger, had larger tumors, macrometastasis and extranodal extension in both populations. Compared with the Z0011 cohort, our BCT patients had more T1 tumors (76.0% vs 69.3%, <italic>P</italic>
 = .01) and more grade II–III tumors (87.3% vs 76.2%, <italic>P</italic>
 < .0001). After adjusting for T-stage, there were no significant differences in DFS and OS between patients undergoing SLND alone or ALND in both populations.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">Examination of our breast cancer patients with Z0011 trial criteria suggests that almost 75% of SLN-positive patients would be candidates to avoid ALND if they undergo BCT.</p>
</sec>
</div>
</front>
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<name sortKey="Yi, Min" sort="Yi, Min" uniqKey="Yi M" first="Min" last="Yi">Min Yi</name>
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Impact of the ACOSOG Z0011 Criteria Applied to a Contemporary Patient Population

Impact of the ACOSOG Z0011 Criteria Applied to a Contemporary Patient Population

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