Molecular type and maximal metastasis diameter influence risk of axillary recurrence in breast cancer patients after positive sentinel lymph node biopsy
Abstract
Background: Breast cancer patients with positive sentinel lymph node biopsy (SLNB) may be spared axillary lymph node dissection (ALND) in favour of irradiation. The aim of the study was to estimate local control probability in the axilla (axLCP).
Materials and methods: We identified 1832 invasive breast cancer patients who had undergone SLNB at our centre. We measured maximal metastasis diameter (SLDmax) in the sentinel lymph nodes and lymph node metastasis volume (VALN) from ALND in 246 patients with one or two positive SLNs. We calculated axLCP after irradiation and systemic treatment for different molecular types.
Results: VALN values are higher for high grade tumours and larger metastases in SLNs ( > 5 mm). It is smaller in luminal A tumours. axLCP is high, nearly 100%, in all molecular types in radiation sensitive tumours (SF2Gy = 0.45), except luminal B. Expected axLCP is relatively low (67%) in luminal B radiation sensitive tumours with no chemotherapy and nearly 100% with chemotherapy.
Conclusion: VALN values differ among molecular tumour types. They depend on SLNDmax and tumour grade. New prognostic factors are needed for selected luminal B breast cancer patients (i.e. high grade tumours, large metastases in SLNs) after positive SLNB intended to be spared ALND and chemotherapy.
Keywords: breast cancersentinel lymph noderadiotherapyaxillary lymph node dissectionprognostic factor
References
- Hunt KK, Ballman KV, McCall LM, et al. Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial. Ann Surg. 2012; 256(3): 428–436.
- Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006; 98(9): 599–609.
- Galimberti V, Cole B, 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(4): 297–305.
- Solá M, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013; 20(1): 120–127.
- Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010; 252(3): 426–32; discussion 432.
- 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(12): 1303–1310.
- NCCN Clinical Practice Guidelines in Oncology (2019) Breast Cancer ver. 1. www.nccn.org/professionals/physician_gls/pdf/breast.pdf (14 March 2019).
- Curigliano G, Burstein HJ, P Winer E, et al. Panel Members of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017, St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol. 2017; 28(8): 1700–1712.
- Falco M, Masojć B, Byrski T, et al. The diameter of metastasis in positive sentinel lymph node biopsy affects axillary tumor load in early breast cancer. Asia Pac J Clin Oncol. 2019; 15(3): 121–127.
- Marks L. A standard dose of radiation for “microscopic disease” is not appropriate. Cancer. 1990; 66(12): 2498–2502, doi: 10.1002/1097-0142(19901215)66:12<2498::aid-cncr2820661209>3.0.co;2-x.
- Katz A, Smith BL, Golshan M, et al. Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. J Clin Oncol. 2008; 26(13): 2093–2098.
- Piñero-Madrona A, Ruiz-Merino G, Bernet L, et al. Tumoral load quantification of positive sentinel lymph nodes in breast cancer to predict more than two involved nodes. Breast. 2014; 23(6): 859–864.
- Schipper RJ, Moossdorff M, Nelemans PJ, et al. A model to predict pathologic complete response of axillary lymph nodes to neoadjuvant chemo(immuno)therapy in patients with clinically node-positive breast cancer. Clin Breast Cancer. 2014; 14(5): 315–322.
- Wazer DE, Morr J, Erban JK, et al. The effects of postradiation treatment with tamoxifen on local control and cosmetic outcome in the conservatively treated breast. Cancer. 1997; 80(4): 732–740, doi: 10.1002/(sici)1097-0142(19970815)80:4<732::aid-cncr12>3.0.co;2-u.
- Buchholz TA, Tucker SL, Erwin J, et al. Impact of systemic treatment on local control for patients with lymph node-negative breast cancer treated with breast-conservation therapy. J Clin Oncol. 2001; 19(8): 2240–2246.
- Ruka W, Taghian A, Gioioso D, et al. Comparison between the in vitro intrinsic radiation sensitivity of human soft tissue sarcoma and breast cancer cell lines. J Surg Oncol. 1996; 61(4): 290–294, doi: 10.1002/(SICI)1096-9098(199604)61:4<290::AID-JSO13>3.0.CO;2-A.
- Speers C, Zhao S, Liu M, et al. Development and Validation of a Novel Radiosensitivity Signature in Human Breast Cancer. Clin Cancer Res. 2015; 21(16): 3667–3677.
- Bulte JP, van Wely BJ, Kasper S, et al. Long-term follow-up of axillary recurrences after negative sentinel lymph node biopsy: effect on prognosis and survival. Breast Cancer Res Treat. 2013; 140(1): 143–149.
- Laurberg T, Tramm T, Nielsen T, et al. Intrinsic subtypes and benefit from postmastectomy radiotherapy in node-positive premenopausal breast cancer patients who received adjuvant chemotherapy - results from two independent randomized trials. Acta Oncol. 2018; 57(1): 38–43.