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
| Autor: | Kevin McKevitt, Aoife Lowery, Matthew G Davey, Éanna J Ryan, Michael J. Kerin, Daniel Burke, Peter McAnena |
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| Rok vydání: | 2021 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Adjuvant chemotherapy Sentinel lymph node oncogeriatrics surgical oncology 03 medical and health sciences Breast cancer 0302 clinical medicine Surgical oncology Internal medicine Biopsy Adjuvant therapy Medicine 030212 general & internal medicine RC254-282 Original Research medicine.diagnostic_test business.industry Neoplasms. Tumors. Oncology. Including cancer and carcinogens personalized medicine medicine.disease Node negative 030220 oncology & carcinogenesis Personalized medicine business |
| Zdroj: | Breast Cancer : Basic and Clinical Research Breast Cancer: Basic and Clinical Research, Vol 15 (2021) |
| ISSN: | 1178-2234 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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