International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases |
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Authors: | Tuomo J. Meretoja R. A. Audisio P. S. Heikkilä R. Bori I. Sejben P. Regitnig G. Luschin-Ebengreuth J. Zgajnar A. Perhavec B. Gazic G. Lázár T. Takács B. Kővári Z. A. Saidan R. M. Nadeem I. Castellano A. Sapino S. Bianchi V. Vezzosi E. Barranger R. Lousquy R. Arisio M. P. Foschini S. Imoto H. Kamma T. F. Tvedskov M.-B. Jensen G. Cserni M. H. K. Leidenius |
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Affiliation: | 1. Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland 2. Department of Surgery, St Helens Teaching Hospital, St Helens, UK 3. Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland 4. Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemet, Hungary 5. Department of Pathology, Medical University of Graz, Graz, Austria 6. Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria 7. Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia 8. Department of Pathology, Institute of Oncology, Ljubljana, Slovenia 9. Department of Surgery, University of Szeged, Szeged, Hungary 10. Department of Pathology, University of Szeged, Szeged, Hungary 11. Department of Breast Surgery, Lancashire Teaching Hospitals, Chorley, UK 12. Breast Unit Azienda Ospedaliera Città della Salute e della Scienza of Torino, Department of Medical Sciences, University of Torino, Turin, Italy 13. Section of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy 14. Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France 15. Department of Pathology, O.I.R.M.-Sant‘Anna Hospital, Turin, Italy 16. Section of Anatomic Pathology at Bellaria Hospital, Department of Biomedical Sciences and Neuromotory Disorders, University of Bologna, Bologna, Italy 17. Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan 18. Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan 19. Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark 20. Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
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Abstract: | Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer due to a growing body of literature. However, existing guidelines of adjuvant treatment planning are strongly based on axillary nodal stage. In this study, we aim to develop a novel international multicenter predictive tool to estimate a patient-specific risk of having four or more tumor-positive axillary lymph nodes (ALN) in patients with macrometastatic sentinel node(s) (SN). A series of 675 patients with macrometastatic SN and completion ALND from five European centers were analyzed by logistic regression analysis. A multivariate predictive model was created and validated internally by 367 additional patients and then externally by 760 additional patients from eight different centers. All statistical tests were two-sided. Prevalence of four or more tumor-positive ALN in each center’s series (P = 0.010), number of metastatic SNs (P < 0.0001), number of negative SNs (P = 0.003), histological size of the primary tumor (P = 0.020), and extra-capsular extension of SN metastasis (P < 0.0001) were included in the predictive model. The model’s area under the receiver operating characteristics curve was 0.766 in the internal validation and 0.774 in external validation. Our novel international multicenter-based predictive tool reliably estimates the risk of four or more axillary metastases after identifying macrometastatic SN(s) in breast cancer. Our tool performs well in internal and external validation, but needs to be further validated in each center before application to clinical use. |
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