Skip to main content

Advertisement

SpringerLink
Log in

Surgical Management of the Axilla in HR+/HER2– Breast Cancer in the Z1071 Era: A Propensity Score-Matched Analysis of the National Cancer Database

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Axillary management varies between sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) for patients with clinical N1 (cN1), hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)/neu-negative (HER2–), infiltrative ductal carcinoma (IDC) who achieve a complete clinical response (cCR) to neoadjuvant systemic therapy (NAST). This study sought to evaluate clinical practice patterns and survival outcomes of SLNB versus ALND in this patient subset.

Methods

Patients with cN1, HR+/HER2–, unilateral IDC demonstrating a cCR to NAST were identified from the 2012–2017 National Cancer Database (NCDB) and stratified based on final axillary surgery management (SLNB vs ALND). After propensity score-matching, overall survival (OS) was compared using a Kaplan-Meier analysis, and significant OS predictors were identified using Cox regression.

Results

Of the 1676 patients selected for this study, 593 (35.4%) underwent SLNB and 1083 (64.6%) underwent ALND. Use of SLNB increased by 28 % between 2012 and 2017. Among a total of 584 matched patients, 461 matched ypN0 patients, and 108 matched ypN+ patients, mean OS did not differ between SLNB and ALND (all patients [92.1 ± 0.8 vs 90.2 ± 1.0 months; p = 0.157], ypN0 patients [92.4 ± 0.8 vs 89.9 ± 0.9 months; p = 0.105], ypN+ patients [83.5 ± 2.3 vs 91.7 ± 2.7 months; p ± 0.963). Cox regression identified age, Charlson score, clinical T stage, and pathologic nodal status as significant predictors of OS.

Conclusion

The final surgical management strategy used for cN1, HR+/HER2– IDC patients who achieved a cCR to NAST did not have a significant impact on survival outcomes in this analysis. Potential opportunities for de-escalation of axillary management among this patient subset exist, and validation studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438–51.

    Article  PubMed  Google Scholar 

  2. Dong JM, Wang HX, Zhong XF, et al. Changes in background parenchymal enhancement in HER2-positive breast cancer before and after neoadjuvant chemotherapy: association with pathologic complete response. Med Baltimore. 2018;97:e12965.

    Article  CAS  Google Scholar 

  3. Ahn S, Woo JW, Lee K, Park SY. HER2 status in breast cancer: changes in guidelines and complicating factors for interpretation. J Pathol Transl Med. 2020;54:34–44.

    Article  PubMed  Google Scholar 

  4. Howlader N, Cronin KA, Kurian AW, Andridge R. Differences in breast cancer survival by molecular subtypes in the United States. Cancer Epidemiol Biomarkers Prev. 2018;27:619–26.

    Article  CAS  PubMed  Google Scholar 

  5. Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer. 1992;66:136–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.

    Article  PubMed  Google Scholar 

  7. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33:258–64.

    Article  PubMed  Google Scholar 

  9. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel lymph node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18.

    Article  PubMed  Google Scholar 

  10. Oshi M, Gandhi S, Angarita FA, et al. A novel five-gene score to predict complete pathological response to neoadjuvant chemotherapy in ER-positive/HER2-negative breast cancer. Am J Cancer Res. 2021;11:3611–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Symmans WF, Wei C, Gould R, et al. Long-term prognostic risk after neoadjuvant chemotherapy associated with residual cancer burden and breast cancer subtype. J Clin Oncol. 2017;35:1049–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) prospective multicenter clinical trial. Ann Surg. 2014;260:608–16 (Discussion 614–606).

    Article  PubMed  Google Scholar 

  13. Lee JS, Yost SE, Yuan Y. Neoadjuvant treatment for triple-negative breast cancer: recent progresses and challenges. Cancers Basel. 2020;12:1404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Anders CK, Abramson V, Tan T, Dent R. The evolution of triple-negative breast cancer: from biology to novel therapeutics. Am Soc Clin Oncol Educ Book. 2016;35:34–42.

    Article  PubMed  Google Scholar 

  15. Torrisi R, Marrazzo E, Agostinetto E, et al. Neoadjuvant chemotherapy in hormone receptor-positive/HER2-negative early breast cancer: when, why, and what? Crit Rev Oncol Hematol. 2021;160:103280.

    Article  PubMed  Google Scholar 

  16. Krag DN, Anderson SJ, Julian TB, et al. Sentinel lymph node resection compared with conventional axillary lymph node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14:297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  19. National Comprehensive Cancer Network. Breast Cancer (version 2.2022). Retrieved 4 January 2022 at https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419.

  20. Naffouje SA, Sabesan A, Hoover SJ, Lee MC, Laronga C. Surgical management of the axilla of HER2+ breast cancer in the Z1071 era: a propensity score-matched analysis of the NCDB. Ann Surg Oncol. 2021;28:8777–88.

    Article  PubMed  Google Scholar 

  21. Naffouje SA, Barker V, Lee MC, Hoover SJ, Laronga C. Surgical management of axilla of triple-negative breast cancer in the Z1071 era: a propensity score-matched analysis of the National Cancer Database. Ann Surg Oncol. 2022;29:2985–97.

    Article  PubMed  Google Scholar 

  22. Rao RD, Cobleigh MA. Adjuvant endocrine therapy for breast cancer. Oncology Williston Park. 2012;26:541–7 (550, 552 passim).

    PubMed  Google Scholar 

  23. Colleoni M, Sun Z, Price KN, et al. Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: results from the International Breast Cancer Study Group trials I to V. J Clin Oncol. 2016;34:927–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15:1303–10.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318:918–26.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol. 2016;23:3467–74.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spring LM, Fell G, Arfe A, et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: a comprehensive meta-analysis. Clin Cancer Res. 2020;26:2838–48.

    Article  PubMed  PubMed Central  Google Scholar 

  28. von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796–804.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Vayda R. Barker BA

  2. Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Samer A. Naffouje MD

  3. Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Melissa A. Mallory MD, Susan A. Hoover MD & Christine Laronga MD

Authors
  1. Vayda R. Barker BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samer A. Naffouje MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa A. Mallory MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan A. Hoover MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine Laronga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: SAN and CL. Acquisition of data: SAN. Analysis and interpretation of data: SAN, VRB, and CL. Drafting of manuscript: SAN, VRB, MAM, and CL. Critical revision: SAN, VRB, MAM, SAH, and CL.

Corresponding author

Correspondence to Vayda R. Barker BA.

Ethics declarations

Disclosure

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 51 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barker, V.R., Naffouje, S.A., Mallory, M.A. et al. Surgical Management of the Axilla in HR+/HER2– Breast Cancer in the Z1071 Era: A Propensity Score-Matched Analysis of the National Cancer Database. Ann Surg Oncol 30, 8371–8380 (2023). https://doi.org/10.1245/s10434-023-14029-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-14029-7

Search

Navigation