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Axillary lymph node and non-sentinel lymph node metastasis among the ACOSOG Z0011 eligible breast cancer patients with invasive ductal, invasive lobular, or other histological special types: a multi-institutional retrospective analysis

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Abstract

Purpose

Given the histological special types (HST) of breast carcinoma accounted for minority of the Z0011 study population, this study aimed to assess the rates of axillary lymph node (ALN) involvement and non-sentinel lymph node (SLN) metastasis in patients with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), or other HST.

Methods

Patients with cT1-2N0M0 breast cancer treated between 2009 and 2018 were retrospectively included from a multi-institutional database. Rates of nodal involvement were analyzed among different histological subgroups. The impact of ALN dissection (ALND) on adjuvant treatment decisions and prognosis were also analyzed among patients with 1–2 + SLNs.

Results

A total of 8294 patients were included: 6854 (82.6%), 257 (3.1%), and 1183 (14.3%) patients with IDC, ILC, and other HST, respectively. IDC patients had a significantly higher rate of ALN metastasis compared with ILC or other HST (31.9% vs. 22.6% vs. 16.4%, P < 0.001). However, in patients with 1–2 + SLNs, rates of non-SLN metastasis were similar among three groups (IDC: n = 182, 28.6% vs. ILC: n = 5, 31.2% vs. other HST: n = 29, 34.9%, P = 0.481). For patients with 1–2 + SLNs, rates of adjuvant chemotherapy and the estimated 3-year recurrence-free survival were similar between the SLN biopsy and ALND arms, regardless of the histological types.

Conclusion

Among patients with 1–2 + SLNs, ILC or other HST had similar rates of non-SLN metastasis compared with IDC. Omission of ALND may not influence adjuvant chemotherapy usage or disease outcome regardless of histological types.

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Data availability

The datasets analyzed in the present study are available from the corresponding author on reasonable request.

Abbreviations

ACOSOG:

American College of Surgeons Oncology Group

ALND:

Axillary lymph node dissection

SLN:

Sentinel lymph node

BCS:

Breast-conserving surgery

IDC:

Invasive ductal carcinoma

HST:

Histological special type

ILC:

Invasive lobular carcinoma

Non-SLN:

Non-sentinel lymph node

SJTU-BCDB:

Shanghai Jiao Tong University-Breast Cancer Database

ER:

Estrogen receptor

PR:

Progesterone receptor

Her-2:

Human epidermal growth factor receptor-2

SLNR:

Sentinel lymph node ratio

RFS:

Recurrence-free survival

DCIS:

Ductal carcinoma in situ

OS:

Overall survival

SLNB:

Sentinel lymph node biopsy

OR:

Odds ratio

CI:

Confidence interval

ASCO:

American Society of Clinical Oncology

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Acknowledgements

The authors would like to thank Ms Yidong Du for her work in the development of SJTU-BCDB.

Funding

This study was supported by the National Natural Science Foundation of China (81772797), the Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20172007), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine—“Guangci Excellent Youth Training Program” (GCQN-2017-A18).

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Author notes

  1. Weiqi Gao and Yufei Zeng have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China

    Weiqi Gao, Yufei Zeng, Xiaosong Chen & Kunwei Shen

  2. Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China

    Xiaochun Fei

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  1. Weiqi Gao
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by WG, XF, XC, and YZ. WG, YZ, and XC wrote the first draft of the manuscript, and KS revised the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiaosong Chen or Kunwei Shen.

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The authors declare no conflicts of interest.

Ethical approval

The present study was reviewed and approved by independent ethical committees of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gao, W., Zeng, Y., Fei, X. et al. Axillary lymph node and non-sentinel lymph node metastasis among the ACOSOG Z0011 eligible breast cancer patients with invasive ductal, invasive lobular, or other histological special types: a multi-institutional retrospective analysis. Breast Cancer Res Treat 184, 193–202 (2020). https://doi.org/10.1007/s10549-020-05842-9

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