Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Ann Surg Oncol. 2017 Nov;24(12):3559-3566. doi: 10.1245/s10434-017-6075-0. Epub 2017 Sep 6.
The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of axillary surgery among women eligible for Z0011 based on patient age and tumor subtype.
Patients with cT1-2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1-5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND.
The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes.
Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of axillary surgery differed by patient age and tumor subtype.
美国外科医师学院肿瘤学组（ACOSOG）Z0011 试验确立了对接受保乳术的早期乳腺癌伴有限淋巴结疾病患者行腋窝淋巴结清扫术（ALND）的安全性。我们根据患者年龄和肿瘤亚型，研究了符合 Z0011 条件的女性行腋窝手术的范围。
从 2009 年至 2014 年，国家癌症数据库中确定了接受保乳术治疗的 cT1-2、cN0 乳腺癌患者，这些患者有一个或两个阳性淋巴结且诊断为乳腺癌。前哨淋巴结活检（SLNB）定义为切除 1-5 个淋巴结，ALND 定义为切除 10 个或更多淋巴结。肿瘤亚型分为 luminal、人表皮生长因子受体 2 阳性（HER2+）或三阴性。使用逻辑回归估计仅接受 SLNB 与 ALND 的几率。
28631 例患者符合纳入标准（21029 例接受 SLNB 治疗，7602 例接受 ALND 治疗）。70 岁或以上的患者更有可能接受 SLNB 治疗而非 ALND（27.0%比 20.1%；p<0.001）。接受 SLNB 治疗后，放疗使用率为 89.4%，接受 ALND 治疗后为 89.7%。多变量分析显示，Z0011 推荐的接受率随时间推移而增加（2014 年比 2009 年：比值比[OR]13.02；p<0.001）。年轻患者比老年患者更不可能接受 SLNB 治疗（年龄<40 岁与≥70 岁：OR 0.59；p<0.001）。HER2+（OR 0.89）或三阴性疾病（OR 0.79）（p<0.001）患者比 luminal 型患者更不可能接受 SLNB 治疗。
在所有组中，符合 ACOSOG Z0011 条件的女性中，SLNB 治疗的使用率随时间推移而增加，但腋窝手术的范围因患者年龄和肿瘤亚型而异。
