Matthew G Davey, Éanna J Ryan, Daniel Burke, Kevin McKevitt, Peter F McAnena, Michael J Kerin, Aoife J Lowery
{"title":"评价老年雌激素受体阳性、临床淋巴结阴性乳腺癌患者常规前哨淋巴结活检的临床应用及辅助化疗的价值","authors":"Matthew G Davey, Éanna J Ryan, Daniel Burke, Kevin McKevitt, Peter F McAnena, Michael J Kerin, Aoife J Lowery","doi":"10.1177/11782234211022203","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial.</p><p><strong>Aims: </strong>To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN-) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making.</p><p><strong>Methods: </strong>Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2-), and cLN- breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes.</p><p><strong>Results: </strong>A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB- patients (15.2%) (<i>P</i> < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age (<i>P</i> < .001), SLNB+ (<i>P</i> < .001) and ODX score (<i>P</i> = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, <i>P</i> = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free (<i>P</i> = .485 and <i>P</i> = .345) or overall survival (<i>P</i> = .981 and <i>P</i> = .646).</p><p><strong>Conclusions: </strong>Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN- EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":"15 ","pages":"11782234211022203"},"PeriodicalIF":1.8000,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11782234211022203","citationCount":"4","resultStr":"{\"title\":\"Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer.\",\"authors\":\"Matthew G Davey, Éanna J Ryan, Daniel Burke, Kevin McKevitt, Peter F McAnena, Michael J Kerin, Aoife J Lowery\",\"doi\":\"10.1177/11782234211022203\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial.</p><p><strong>Aims: </strong>To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN-) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making.</p><p><strong>Methods: </strong>Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2-), and cLN- breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes.</p><p><strong>Results: </strong>A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB- patients (15.2%) (<i>P</i> < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age (<i>P</i> < .001), SLNB+ (<i>P</i> < .001) and ODX score (<i>P</i> = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, <i>P</i> = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free (<i>P</i> = .485 and <i>P</i> = .345) or overall survival (<i>P</i> = .981 and <i>P</i> = .646).</p><p><strong>Conclusions: </strong>Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN- EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.</p>\",\"PeriodicalId\":9163,\"journal\":{\"name\":\"Breast Cancer : Basic and Clinical Research\",\"volume\":\"15 \",\"pages\":\"11782234211022203\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2021-06-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1177/11782234211022203\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Cancer : Basic and Clinical Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/11782234211022203\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer : Basic and Clinical Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/11782234211022203","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 4
摘要
背景:前哨淋巴结活检(SLNB)提供分期信息，指导早期乳腺癌(EBC)的辅助治疗。低风险EBC患者的常规SLNB仍有争议。目的:评价雌激素受体阳性(ER+)、临床淋巴结阴性(cLN-) EBC的老年患者腋窝管理，并评估SLNB是否影响进一步腋窝管理或辅助化疗(ACTX)决策。方法:纳入年龄> 65岁、诊断为ER+、人表皮生长因子受体-2阴性(HER2-)、cLN-乳腺癌(BC)、行手术和SLNB的女性患者。确定ACTX和完全性腋窝淋巴结清扫(CALND)的临床病理预测因子。Kaplan-Meier分析评估了生存结果。结果:共纳入253例患者(中位年龄:72岁，范围:66-90岁)，均行SLNB;50例(19.8%)发生淋巴转移(SLNB+)。其中19例(38.0%)发展为CALND, 10例(52.6%)进一步发展为腋窝病变(ALND+)。50例SLNB+患者中有20例(40.0%)使用了ACTX, 203例SLNB-患者中有31例(15.2%)(P P P = 0.003)均与ACTX处方相关。ODX > 25 (OR: 4.37, 95% CI: 1.38 ~ 13.80, P = 0.012)独立预测接受ACTX治疗。接受ACTX治疗并继续进行CALND治疗并没有改善无病情况(P =。485和P = .345)或总生存率(P =。P = .646)。结论:对于诊断为ER+， cLN- EBC的老年患者，常规SNLB可能没有必要。未来的肿瘤学实践可能会看到基因组测试指导这一组的ACTX处方。
Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer.
Background: Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial.
Aims: To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN-) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making.
Methods: Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2-), and cLN- breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes.
Results: A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB- patients (15.2%) (P < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age (P < .001), SLNB+ (P < .001) and ODX score (P = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, P = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free (P = .485 and P = .345) or overall survival (P = .981 and P = .646).
Conclusions: Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN- EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.
期刊介绍：
Breast Cancer: Basic and Clinical Research is an international, open access, peer-reviewed, journal which considers manuscripts on all areas of breast cancer research and treatment. We welcome original research, short notes, case studies and review articles related to breast cancer-related research. Specific areas of interest include, but are not limited to, breast cancer sub types, pathobiology, metastasis, genetics and epigenetics, mammary gland biology, breast cancer models, prevention, detection, therapy and clinical interventions, and epidemiology and population genetics.
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