Cancer Research and Treatment

Original Articles

Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes: Ji Hyeon Joo, Su Ssan Kim, Byung Ho Son, Seung Do Ahn, Jin Hong Jung, Eun Kyung Choi, Sei Hyun Ahn, Jong Won Lee, Hee Jeong Kim, Beom Seok Ko; Cancer Res Treat. 2019;51(3):1011-1021. Published online October 16, 2018; DOI: https://doi.org/10.4143/crt.2018.438

Abstract PDF Supplementary Material PubReader ePub

Purpose
Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs.
Materials and Methods
A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method.
Results
Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months.
Conclusion
ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.

Citations

Citations to this article as recorded by

The Impact of Sentinel Lymph Node Biopsy on Female Patients With T3-4c Breast Cancer and 1-2 Positive Lymph Nodes: A Population-Based Cohort Study
Hanzhao Yang, Yadong Sun, Peili Wang, Jianghua Qiao, Chengzheng Wang, Zhenzhen Liu
Clinical Breast Cancer.2024; 24(3): e126. CrossRef
Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis
Changzai Li, Pan Zhang, Jie Lv, Wei Dong, Baoshan Hu, Jinji Zhang, Hongcheng Zhu
Frontiers in Oncology.2024;[Epub] CrossRef
Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from a Meta-Analysis including the SINODAR-ONE Trial
Munaser Alamoodi, Neill Patani, Kinan Mokbel, Umar Wazir, Kefah Mokbel
Cancers.2024; 16(4): 742. CrossRef
RecurIndex-Guided postoperative radiotherapy with or without Avoidance of Irradiation of regional Nodes in 1–3 node-positive breast cancer (RIGAIN): a study protocol for a multicentre, open-label, randomised controlled prospective, phase III trial
Jing Liu, Yuting Tan, Zhuofei Bi, Suning Huang, Na Zhang, An-du Zhang, Lina Zhao, Yu Wang, Zibin Liang, Yu Hou, Xiangying Xu, Jianying Chen, Fei Wang, Xiaowen Lan, Xiao Lin, Xiaoxue Zhang, Wenyi Zhou, Xuting Ye, Jian-gui Guo, Xiaohong Wang, Ran Ding, Jiay
BMJ Open.2024; 14(7): e078049. CrossRef
The prognostic analysis of further axillary dissection in breast cancer with 1-2 positive sentinel lymph nodes undergoing mastectomy
Xueyi Zhao, Liu Yang, Congbo Cao, Zhenchuan Song
Frontiers in Oncology.2024;[Epub] CrossRef
Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy
Damiano GENTILE, Corrado TINTERRI
Minerva Surgery.2024;[Epub] CrossRef
Can Axillary Lymph Node Dissection be Omitted in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes Undergoing Mastectomy? A Systematic Review and Meta‐Analysis of Real‐World Evidence
Fulong Chen, Xiaowen Li, Xianjun Lin, Lijia Chen, Zhaoling Lin, Hao Wu, Jishang Chen
World Journal of Surgery.2023; 47(10): 2446. CrossRef
De-implementation of Axillary Dissection in Women Undergoing Mastectomy for Breast Cancer
Laura D. Leonard, Thiago B. de Araujo, Christopher Quinn, Madeline B. Thomas, Laurel Beaty, Nicole M. Mott, Kathryn Colborn, Alicia A. Heelan, Sarah E. A. Tevis, Nicole Christian, Gretchen Arhendt, Ana L. Gleisner
Annals of Surgical Oncology.2023; 30(9): 5692. CrossRef
A multi-dimensional nomogram to predict non-sentinel lymph node metastases in T1–2HR+ breast cancer
Ke Xiang, Jialin Chen, Yu Min, Hang Chen, Jiaxin Yang, Daixing Hu, Yuling Han, Guobing Yin, Yang Feng
Frontiers in Endocrinology.2023;[Epub] CrossRef
Sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients undergoing mastectomy with one to two metastatic sentinel lymph nodes: sub-analysis of the SINODAR-ONE multicentre randomized clinical trial and reopening of enrolm
Corrado Tinterri, Giuseppe Canavese, Wolfgang Gatzemeier, Erika Barbieri, Alberto Bottini, Andrea Sagona, Giulia Caraceni, Alberto Testori, Simone Di Maria Grimaldi, Carla Dani, Luca Boni, Paolo Bruzzi, Bethania Fernandes, Marta Scorsetti, Alberto Zambell
British Journal of Surgery.2023; 110(9): 1143. CrossRef
Efficacy and safety comparison between axillary lymph node dissection with no axillary surgery in patients with sentinel node-positive breast cancer: a systematic review and meta-analysis
Yu-Jia Fan, Jin-Cheng Li, De-Miao Zhu, Hai-Long Zhu, Yi Zhao, Xin-Bing Zhu, Gang Wu, Ting-ting Bai
BMC Surgery.2023;[Epub] CrossRef
Factores predictivos de metástasis en ganglios no centinela en el cáncer de mama con ganglio centinela positivo
Mariana Peyroteo, Rita Canotilho, Ana Margarida Correia, Catarina Baía, Cátia Ribeiro, Paulo Reis, Abreu de Sousa
Cirugía Española.2022; 100(2): 81. CrossRef
Optimizing Axillary Management in Clinical T1-2N0 Mastectomy Patients with Positive Sentinel Lymph Nodes
Olga Kantor, Jessica Means, Samantha Grossmith, Tanujit Dey, Jennifer R. Bellon, Elizabeth A. Mittendorf, Tari A. King
Annals of Surgical Oncology.2022; 29(2): 972. CrossRef
Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node
Mariana Peyroteo, Rita Canotilho, Ana Margarida Correia, Catarina Baía, Cátia Ribeiro, Paulo Reis, Abreu de Sousa
Cirugía Española (English Edition).2022; 100(2): 81. CrossRef
Axilla lymph node dissection can be safely omitted in patients with 1–2 positive sentinel nodes receiving mastectomy: a large multi-institutional study and a systemic meta-analysis
Weiqi Gao, Shuangshuang Lu, Yufei Zeng, Xiaosong Chen, Kunwei Shen
Breast Cancer Research and Treatment.2022; 196(1): 129. CrossRef
Comparison of survival outcomes between axillary conservation and axillary lymph node dissections in N1 early breast cancer: a propensity-matched SEER analysis
Nisha Wu, Xiaohan Su, Qiao Tan, Jing Luo, Yewei Yuan, Lingmi Hou, Junyan Li
Clinical and Translational Oncology.2022; 25(4): 1091. CrossRef
Surgeon Bias in the Management of Positive Sentinel Lymph Nodes
Brittany J. Mathias, James Sun, Weihong Sun, Jun-Min Zhou, William J. Fulp, Christine Laronga, M. Catherine Lee, John V. Kiluk
Clinical Breast Cancer.2021; 21(1): 74. CrossRef
Impact of Axillary Dissection Among Patients With Sentinel Node–Positive Breast Cancer Undergoing Mastectomy
James Sun, Brittany J. Mathias, Christine Laronga, Weihong Sun, Jun-Min Zhou, William J. Fulp, John V. Kiluk, M. Catherine Lee
Journal of the National Comprehensive Cancer Network.2021; 19(1): 40. CrossRef
Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study
André Hennigs, Fabian Riedel, Manuel Feißt, Melitta Köpke, Mahdi Rezai, Ulrike Nitz, Mareike Moderow, Michael Golatta, Christof Sohn, Jörg Heil
Annals of Surgical Oncology.2019; 26(8): 2435. CrossRef

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Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?: Sung Uk Bae, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim; Cancer Res Treat. 2018;50(3):712-719. Published online July 14, 2017; DOI: https://doi.org/10.4143/crt.2017.100

Abstract PDF PubReader ePub

Purpose
The prognosis of patientswith colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM.
Materials and Methods
We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009.
Results
In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with ≤ 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA ≤ 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with ≤ 7 positive PALN and CEA level ≤ 5.
Conclusion
PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.

Citations

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Prognostic factors of para-aortic lymph node metastasis from colorectal cancer in highly selected patients undergoing para-aortic lymph node dissection
Shin Emoto, Yosuke Fukunaga, Manabu Takamatsu, Hiroshi Kawachi, Shuhei Sano, Tetsuro Tominaga, Toshiki Mukai, Tomohiro Yamaguchi, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Satoshi Nagayama, Masashi Ueno
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Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence
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Annals of Surgical Oncology.2024; 31(4): 2378. CrossRef
Para-aortic Lymph Node Dissection for Colorectal Cancer: Predicting Pathologic Lymph Node Positivity and Optimizing Outcomes
Neal Bhutiani, Kentaro Ochiai, Muhammad O. Awiwi, Miguel A. Rodriguez-Bigas, Abhineet Uppal, Oliver Peacock, Craig Messick, Michael G. White, John M. Skibber, Brian K. Bednarski, Y. Nancy You, George J. Chang, Harmeet Kaur, Tsuyoshi Konishi
Annals of Surgical Oncology.2024; 31(9): 5962. CrossRef
Surgery for Infrarenal Retroperitoneal Node Metastases from Colon Cancer
Anne-Sophie Dulac, Pietro Genova, Olivier Benoit, Cindy Neuzillet, Mostapha El Hajjam, Jean-François Emile, Frédérique Peschaud, Renato Micelli Lupinacci
Journal of Gastrointestinal Cancer.2024; 55(3): 1306. CrossRef
Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study
Sono Ito, Yusuke Kinugasa, Shinichi Yamauchi, Hiroyuki Sato, Akihiro Hirakawa, Soichiro Ishihara, Akio Shiomi, Yukihide Kanemitsu, Takeshi Suto, Hiroki Takahashi, Michio Itabashi, Manabu Shiozawa, Masaya Hiyoshi, Takaya Kobatake, Koji Komori, Hiroyuki Egi
Diseases of the Colon & Rectum.2024; 67(11): 1423. CrossRef
Long-Term Outcome After Resection of Hepatic and Pulmonary Metastases in Multivisceral Colorectal Cancer
Christopher Berlin, Geoffroy Andrieux, Magdalena Menzel, Gabriel J. Stöger, Andreas Gengenbach, Luisa Schäfer, Hans C. Hillebrecht, Rebecca Kesselring, Uyen-Thao Le, Stefan Fichtner-Feigl, Philipp A. Holzner
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Survival outcomes after synchronous para‐aortic lymph node metastasis in colorectal cancer: A systematic review
Conor Aylward, Jawed Noori, Jack Tyrrell, Niall O'sullivan, Dara O. Kavanagh, John O. Larkin, Brian J. Mehigan, Paul H. McCormick, Michael E. Kelly
Journal of Surgical Oncology.2023; 127(4): 645. CrossRef
Retroperitoneal Lymph Node Dissection in Colorectal Cancer with Lymph Node Metastasis: A Systematic Review
Michael G. Fadel, Mosab Ahmed, Gianluca Pellino, Shahnawaz Rasheed, Paris Tekkis, David Nicol, Christos Kontovounisios, Erik Mayer
Cancers.2023; 15(2): 455. CrossRef
The management of clinically suspicious para‐aortic lymph node metastasis in colorectal cancer: A systematic review
Michelle Zhiyun Chen, Yeng Kwang Tay, Swetha Prabhakaran, Joseph C Kong
Asia-Pacific Journal of Clinical Oncology.2023; 19(6): 596. CrossRef
Survival benefits of para-aortic lymphadenectomy in colorectal cancer with clinically suspected para-aortic lymph node metastasis: a meta-analysis and systematic review
Rong-Chang Wang, Jian-Qi Wang, Xiao-Yu Zhou, Chu-lin Zhong, Jin-Xu Chen, Jing-Song Chen
World Journal of Surgical Oncology.2023;[Epub] CrossRef
Influence of Extraperitoneal Metastases on the Curative-Intent Management of Colorectal Peritoneal Metastases
Frédéric Schell, Amaniel Kefleyesus, Nazim Benzerdjeb, Guillaume Passot, Pascal Rousset, Alhadeedi Omar, Laurent Villeneuve, Julien Péron, Olivier Glehen, Vahan Kepenekian
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Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis
Qingwei Ren, Yanyan Chen, Xuejun Shao, Lanzhong Guo, Xinxin Xu
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Oncologic Outcomes after Surgical Resection for Para-aortic Lymph Node Metastasis in Colorectal Cancer
Takayuki Okuno, Masaya Hiyoshi, Yuusuke Kyoden, Junji Yamamoto
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Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study: Se Hyun Kim, Kyung Hae Jung, Tae-Yong Kim, Seock-Ah Im, In Sil Choi, Yee Soo Chae, Sun Kyung Baek, Seok Yun Kang, Sarah Park, In Hae Park, Keun Seok Lee, Yoon Ji Choi, Soohyeon Lee, Joo Hyuk Sohn, Yeon-Hee Park, Young-Hyuck Im, Jin-Hee Ahn, Sung-Bae Kim, Jee Hyun Kim; Cancer Res Treat. 2016;48(4):1373-1381. Published online March 23, 2016; DOI: https://doi.org/10.4143/crt.2015.475

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy.
Materials and Methods
This retrospective analysis is based on the data of 814 patientswith stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model.
Results
A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] –, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2– subtype.
Conclusion
LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2– patients is notable and worthy of further investigation.

Citations

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Breast Cancer Patients With Positive Apical or Infraclavicular/Ipsilateral Supraclavicular Lymph Nodes Should Be Excluded in the Application of the Lymph Node Ratio System
Zhe Wang, Wei Chong, Huikun Zhang, Xiaoli Liu, Yawen Zhao, Zhifang Guo, Li Fu, Yongjie Ma, Feng Gu
Frontiers in Cell and Developmental Biology.2022;[Epub] CrossRef
The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis
Jinzhao Liu, Yifei Li, Weifang Zhang, Chenhui Yang, Chao Yang, Liang Chen, Mingjian Ding, Liang Zhang, Xiaojun Liu, Guozhong Cui, Yunjiang Liu
Frontiers in Surgery.2022;[Epub] CrossRef
Prognostic implications of regression of metastatic axillary lymph nodes after neoadjuvant chemotherapy in patients with breast cancer
Yul Ri Chung, Ji Won Woo, Soomin Ahn, Eunyoung Kang, Eun-Kyu Kim, Mijung Jang, Sun Mi Kim, Se Hyun Kim, Jee Hyun Kim, So Yeon Park
Scientific Reports.2021;[Epub] CrossRef
Using a novel T-lymph node ratio model to evaluate the prognosis of nonmetastatic breast cancer patients who received preoperative radiotherapy followed by mastectomy
Yang Wang, Yuanyuan Zhao, Song Liu, Weifang Tang, Hong Gao, Xucai Zheng, Shikai Hong, Shengying Wang
Medicine.2017; 96(42): e8203. CrossRef
The genetic variants in the PTEN/PI3K/AKT pathway predict susceptibility and CE(A)F chemotherapy response to breast cancer and clinical outcomes
Xiang Li, Ruishan Zhang, Zhuangkai Liu, Shuang Li, Hong Xu
Oncotarget.2017; 8(12): 20252. CrossRef
Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy
Ji Hyun Chang, Wan Jeon, Kyubo Kim, Kyung Hwan Shin, Wonshik Han, Dong-Young Noh, Seock-Ah Im, Tae-You Kim, Yung-Jue Bang
Journal of Breast Cancer.2016; 19(4): 394. CrossRef

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Effectiveness of Sentinel Node Biopsy in the Prediction of Axillary Nodal Status in 111 Patients with Breast Cancer: Jeong Hyun Yang, Hae Kyung Lee, Seok Jin Nam; J Korean Cancer Assoc. 1998;30(5):951-955.

Abstract PDF: PURPOSE
Recently, results of many trials that intend to decide the axillary status through more conservative procedures are reported. One of these is sentinel node biopsy. This method is regarded as reasonable and selective. Some investigators tend to omit axillary dissection in the patient who is determined to have negative node clinically and negative result in sentinel node biopsy procedure. This study was designed to know how accurate the sentinel node biopsy method can predict axillary nodal status.
MATERIALS AND METHOD
The patients group was selected from Department of Surgery at SMC, consisting of 111 patients with surgically curable breast cancer from Sept. 1995 to Apr. 1997. Isosulfan blue was injected in the center of mass and the margins of 4 quadrant under the general anesthesia. Axillary dissection was done 5 minutes after injection to identify the stained lymphatics. When stained lymphatics were identified, dissection was performed along the lymphatics bidirectionally to detect the stained lymph node nearest to the primary tumor (sentinel node). After frozen biopsy of sentinel node, routine axillary node dissection was performed. Results of frozen biopsy were compared with the final pathologic results.
RESULTS
Sentinel node was detected in 80 of the 111 cases (72.1%) and there were 44 (55.0%) axillary metastasis cases in sentinel node detection group. In 14 of 44 cases, sentinel node was only positive. In 5 of 41, sentinel node were falsely negative for malignancy. Negative predictive value of the method is 87.8% (36/41).
CONCLUSION
Sentinel node biopsy method can predict the axillary nodal status in patients with breast cancer. This method can lead to more conservative treatment, eventually omitting axillary nodal dissection in selected patients.

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