Patterns of nodal staging during breast conservation surgery in the medicare patient: will the ACOSOG Z0011 trial change the pattern of care?
Identifieur interne : 001923 ( Pmc/Checkpoint ); précédent : 001922; suivant : 001924Patterns of nodal staging during breast conservation surgery in the medicare patient: will the ACOSOG Z0011 trial change the pattern of care?
Auteurs : Catherine E. Loveland-Jones ; Karen Ruth ; Elin R. Sigurdson ; Brian L. Egleston ; Marcia Boraas ; Richard J. BleicherSource :
- Breast cancer research and treatment [ 0167-6806 ] ; 2014.
Abstract
ACOSOG Z0011 spares axillary dissection (AD) in breast conservation surgery (BCS) patients with T1/T2 tumors and 1–2 positive nodes. Current patterns of care and the impact of Z0011 on AD versus additional surgery rates for Medicare patients undergoing BCS are unknown. SEER data linked to Medicare claims for 1999–2005 were reviewed for women with invasive non-metastatic breast cancer who underwent nodal staging on the same day as BCS. There were 3,280 women with T1/T2 tumors and positive nodes who underwent same-day nodal staging; 2,532 (77.2 %) of these women had 1–2 positive nodes. Assuming 25.7 % have extracapsular extension, 651 women would require AD. However, 1,881 women, or 57.4 % of those with T1/T2 tumors and positive nodes, would be spared AD. Meanwhile, among the 748 women having ≥3 positive nodes, 579 underwent same-day AD, but under Z0011, would now wait for permanent section. A total of 160 of these women underwent re-excision or completion mastectomy at a later date anyway, when delayed AD could be performed. The remaining 419 women with ≥3 positive nodes would require an additional surgery date for the sole purpose of completion AD. The Z0011 paradigm would consequently necessitate an additional surgery date for 1,070 (651 + 419) women, or 32.6 % of those with T1/T2 tumors and positive nodes. The Z0011 paradigm appears to increase the number of Medicare patients undergoing BCS who require an additional surgery date but decrease the number requiring AD to a greater extent. Future changes in the use of AD or axillary irradiation may yet modify that impact substantially.
Url:
DOI: 10.1007/s10549-014-2834-9
PubMed: 24442687
PubMed Central: 4161134
Affiliations:
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<front><div type="abstract" xml:lang="en"><p id="P1">ACOSOG Z0011 spares axillary dissection (AD) in breast conservation surgery (BCS) patients with T1/T2 tumors and 1–2 positive nodes. Current patterns of care and the impact of Z0011 on AD versus additional surgery rates for Medicare patients undergoing BCS are unknown. SEER data linked to Medicare claims for 1999–2005 were reviewed for women with invasive non-metastatic breast cancer who underwent nodal staging on the same day as BCS. There were 3,280 women with T1/T2 tumors and positive nodes who underwent same-day nodal staging; 2,532 (77.2 %) of these women had 1–2 positive nodes. Assuming 25.7 % have extracapsular extension, 651 women would require AD. However, 1,881 women, or 57.4 % of those with T1/T2 tumors and positive nodes, would be spared AD. Meanwhile, among the 748 women having ≥3 positive nodes, 579 underwent same-day AD, but under Z0011, would now wait for permanent section. A total of 160 of these women underwent re-excision or completion mastectomy at a later date anyway, when delayed AD could be performed. The remaining 419 women with ≥3 positive nodes would require an additional surgery date for the sole purpose of completion AD. The Z0011 paradigm would consequently necessitate an additional surgery date for 1,070 (651 + 419) women, or 32.6 % of those with T1/T2 tumors and positive nodes. The Z0011 paradigm appears to increase the number of Medicare patients undergoing BCS who require an additional surgery date but decrease the number requiring AD to a greater extent. Future changes in the use of AD or axillary irradiation may yet modify that impact substantially.</p>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8111104</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1254</journal-id>
<journal-id journal-id-type="nlm-ta">Breast Cancer Res Treat</journal-id>
<journal-id journal-id-type="iso-abbrev">Breast Cancer Res. Treat.</journal-id>
<journal-title-group><journal-title>Breast cancer research and treatment</journal-title>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Patterns of nodal staging during breast conservation surgery in the medicare patient: will the ACOSOG Z0011 trial change the pattern of care?</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Loveland-Jones</surname>
<given-names>Catherine E.</given-names>
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<aff id="A1">Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA</aff>
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<contrib contrib-type="author"><name><surname>Ruth</surname>
<given-names>Karen</given-names>
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<aff id="A2">Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA</aff>
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<contrib contrib-type="author"><name><surname>Sigurdson</surname>
<given-names>Elin R.</given-names>
</name>
<aff id="A3">Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA 19111, USA</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Egleston</surname>
<given-names>Brian L.</given-names>
</name>
<aff id="A4">Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Boraas</surname>
<given-names>Marcia</given-names>
</name>
<aff id="A5">Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA 19111, USA</aff>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Bleicher</surname>
<given-names>Richard J.</given-names>
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<email>richard.bleicher@fccc.edu</email>
<aff id="A6">Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA 19111, USA</aff>
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<pub-date pub-type="nihms-submitted"><day>31</day>
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<year>2014</year>
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<month>1</month>
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<pub-date pub-type="ppub"><month>2</month>
<year>2014</year>
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<pub-date pub-type="pmc-release"><day>01</day>
<month>2</month>
<year>2015</year>
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<volume>143</volume>
<issue>3</issue>
<fpage>571</fpage>
<lpage>577</lpage>
<pmc-comment>elocation-id from pubmed: 10.1007/s10549-014-2834-9</pmc-comment>
<permissions><copyright-statement>© Springer Science+Business Media New York 2014</copyright-statement>
<copyright-year>2014</copyright-year>
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<abstract><p id="P1">ACOSOG Z0011 spares axillary dissection (AD) in breast conservation surgery (BCS) patients with T1/T2 tumors and 1–2 positive nodes. Current patterns of care and the impact of Z0011 on AD versus additional surgery rates for Medicare patients undergoing BCS are unknown. SEER data linked to Medicare claims for 1999–2005 were reviewed for women with invasive non-metastatic breast cancer who underwent nodal staging on the same day as BCS. There were 3,280 women with T1/T2 tumors and positive nodes who underwent same-day nodal staging; 2,532 (77.2 %) of these women had 1–2 positive nodes. Assuming 25.7 % have extracapsular extension, 651 women would require AD. However, 1,881 women, or 57.4 % of those with T1/T2 tumors and positive nodes, would be spared AD. Meanwhile, among the 748 women having ≥3 positive nodes, 579 underwent same-day AD, but under Z0011, would now wait for permanent section. A total of 160 of these women underwent re-excision or completion mastectomy at a later date anyway, when delayed AD could be performed. The remaining 419 women with ≥3 positive nodes would require an additional surgery date for the sole purpose of completion AD. The Z0011 paradigm would consequently necessitate an additional surgery date for 1,070 (651 + 419) women, or 32.6 % of those with T1/T2 tumors and positive nodes. The Z0011 paradigm appears to increase the number of Medicare patients undergoing BCS who require an additional surgery date but decrease the number requiring AD to a greater extent. Future changes in the use of AD or axillary irradiation may yet modify that impact substantially.</p>
</abstract>
<kwd-group><kwd>Clinical trials</kwd>
<kwd>ACOSOG Z0011</kwd>
<kwd>Lymph node metastases</kwd>
<kwd>Sentinel lymphadenectomy</kwd>
<kwd>Sentinel node biopsy</kwd>
<kwd>Axillary lymphadenectomy</kwd>
<kwd>Axillary lymph node dissection</kwd>
<kwd>Patterns of care</kwd>
<kwd>Surveillance, epidemiology and end results</kwd>
<kwd>Medicare</kwd>
<kwd>Medicare claims</kwd>
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<name sortKey="Egleston, Brian L" sort="Egleston, Brian L" uniqKey="Egleston B" first="Brian L." last="Egleston">Brian L. Egleston</name>
<name sortKey="Loveland Jones, Catherine E" sort="Loveland Jones, Catherine E" uniqKey="Loveland Jones C" first="Catherine E." last="Loveland-Jones">Catherine E. Loveland-Jones</name>
<name sortKey="Ruth, Karen" sort="Ruth, Karen" uniqKey="Ruth K" first="Karen" last="Ruth">Karen Ruth</name>
<name sortKey="Sigurdson, Elin R" sort="Sigurdson, Elin R" uniqKey="Sigurdson E" first="Elin R." last="Sigurdson">Elin R. Sigurdson</name>
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