ASO Author Reflections: Accurately Predicting Nodal pCR Holds the Key to Axillary Surgery De-escalation Strategies

Annals of Surgical Oncology -     

ASO Author Reflections: Selective Nodal Staging and De-escalating Adjuvant Therapy

Annals of Surgical Oncology -     

ASO Author Reflections: Rethinking Palpable Adenopathy as a Marker of High-Volume Axillary Nodal Disease in Hormone Receptor-Positive Breast Cancer

Annals of Surgical Oncology -     

ASO Author Reflections: Timing of Neoadjuvant Chemotherapy in Patients with Sarcoma

Annals of Surgical Oncology -     

ASO Author Reflections: Hilar Cholangiocarcinoma

Annals of Surgical Oncology -     

ASO Author Reflections: Reconsidering Resection for Patients with Poorly Differentiated Pancreatic Neuroendocrine Carcinoma

Annals of Surgical Oncology -     

ASO Author Reflections: Robust Prediction Models for Colon Cancer in Asian Patients

Annals of Surgical Oncology -     

ASO Author Reflections: 30 Years of Esophagectomy

Annals of Surgical Oncology -     

ASO Author Reflections: Clinical Implications of Circulating Tumor DNA in Pancreatic Cancer Patients

Annals of Surgical Oncology -     

ASO Author Reflections: Neutrophil-to-Lymphocyte Ratio Predicts Recurrence Pattern in Patients with Resectable Colorectal Liver Metastases

Annals of Surgical Oncology -     

ASO Author Reflections: Breast-Conserving Therapy: A Safe Option in Young Patients with Early-Stage Breast Cancer

Annals of Surgical Oncology -     

ASO Author Reflections: Perspectives in the Measurement of Rapid Turnover Proteins in Patients with Hepatocellular Carcinoma

Annals of Surgical Oncology -     

ASO Author Reflections: Percutaneous Image-Guided Ablation and Multi-modality Management of Lung Metastases

Annals of Surgical Oncology -     

ASO Author Reflections: Entering the Era of Biomarker-Driven Management of the Axilla

Annals of Surgical Oncology -     

ASO Author Reflections: Retroperitoneal Sarcoma Surgery in the Elderly

Annals of Surgical Oncology -     

ASO Author Reflections: TRPV2 and Gastric Cancer

Annals of Surgical Oncology -     

Predicting Axillary Nodal Positivity in 2282 Patients with Breast Carcinoma

Axillary lymph node status continues to be the single most important prognostic variable for breast cancer survival despite significant progress in the molecular and genetic characterization of breast malignancies. All patients with invasive breast cancer who underwent axillary lymph node dissection as part of their treatment were evaluated by 11 clinical and pathologic factors, including the primary lesion's T category (TNM staging system), whether the lesion was clinically palpable, the presence of lymphatic or vascular invasion, nuclear grade, estrogen and progesterone receptors, S-phase, age, HER2/neu overexpression, histology (infiltrating lobular or ductal), and ploidy. A total of 2282 axillary dissections were performed: 391 in patients with ductal carcinoma in situ (DCIS) [3 of which (0.8%) contained metastases] and 1891 in patients with invasive breast cancer [680 of which (36%) contained metastases]. Multivariate analysis of patients with invasive cancer identified four factors as independent predictors of axillary lymph node metastases: lymph/vascular invasion, tumor size, nuclear grade, tumor palpability. Among a group of 189 patients with nonpalpable, non-high-grade invasive lesions 15 mm or smaller without lymph/vascular invasion, only 6 (3%) had metastases to lymph nodes. If any three of the favorable factors were present, lymph node positivity was 6% or less. Clinical and pathologic feature of the primary lesions can be used to estimate the risk of axillary lymph node metastases. Such risk assessment can be used for the treatment decision-making process.     

ASO Author Reflections: Psychosocial Outcomes After Breast Cancer Treatment

Annals of Surgical Oncology -     

Favorable Outcome of Secondary Axillary Dissection in Breast Cancer Patients with Axillary Nodal Relapse

Purpose

Little evidence can be found about the long-term outcome of breast cancer patients after axillary lymph node recurrence (ALNR) and its survival benefit after different kinds of management. The present study intends to evaluate the risk factors associated with axillary recurrence after definite surgery for primary breast cancer. The prognosis after ALNR and particularly outcome of different management methods also were studied.

Methods

We retrospectively reviewed data from 4,473 patients who were diagnosed with primary breast cancer and received surgical intervention in a single institute from January 1990 to December 2002. Medical files were reviewed and data on survival were updated annually. Risk factors and prognosis of patients with axillary recurrence were analyzed. Breast–cancer-specific survival of patients with ALNR and outcomes after different management methods also were studied.

Results

After a median follow-up of 70.2 months, axillary recurrence developed in 0.8% of patients. Factors associated with ALNR included: age younger than 40 years, medial tumor location, no initial standard level I &; II axillary dissection, and not receiving hormonal therapy. The 5-year breast–cancer-specific survival after ALNR was 57.9%. For patients who received further axillary dissection, the 5-year survival rate was 82.5% compared with 44.9% for patients who did not receive further dissection.

Conclusions

ALNR is a rare event in treating breast cancer. Young age at diagnosis and medially located tumor are associated with higher risk, but standardized initial axillary dissection to level II and adjuvant hormonal therapy is protective against ALNR. In patients with ALNR, the outcome is not dismal and survival may be improved if further axillary dissection is given.