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Breast Cancer Res Treat. 2020 Feb;180(1):207-217. doi: 10.1007/s10549-020-05529-1. Epub 2020 Jan 20.

Extent of axillary surgery in inflammatory breast cancer: a survival analysis of 3500 patients.

Fayanju OM1,2,3,4,5, Ren Y6, Greenup RA7,8,9, Plichta JK7,8, Rosenberger LH7,8, Force J8,10, Suneja G8,11,12, Devi GR7,8, King TA13,14, Nakhlis F13,14, Hyslop T6,15, Hwang ES7,8.

Author information

1
Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA. lola.fayanju@duke.edu.
2
Women's Cancer Program, Duke Cancer Institute, Durham, NC, 27710, USA. lola.fayanju@duke.edu.
3
Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA. lola.fayanju@duke.edu.
4
Duke Forge, Duke University, Durham, NC, 27710, USA. lola.fayanju@duke.edu.
5
Department of Surgery, Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA. lola.fayanju@duke.edu.
6
Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, 27710, USA.
7
Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA.
8
Women's Cancer Program, Duke Cancer Institute, Durham, NC, 27710, USA.
9
Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA.
10
Department of Medicine, Duke University Medical Center, Box 3893, Durham, NC, 27710, USA.
11
Department of Radiation Oncology, Duke University School of Medicine, Box 3085, Durham, NC, 27710, USA.
12
Duke Global Health Institute, Durham, NC, 27710, USA.
13
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.
14
Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02115, USA.
15
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Box 2717, Durham, NC, 27710, USA.

Abstract

PURPOSE:

Inflammatory breast cancer (IBC) is an aggressive variant for which axillary lymph node (LN) dissection following neoadjuvant chemotherapy (NACT) remains standard of care. But with increasingly effective systemic therapy, it is unclear whether more limited axillary surgery may be appropriate in some IBC patients. We sought to examine whether extent of axillary LN surgery was associated with overall survival (OS) for IBC.

METHODS:

Female breast cancer patients with non-metastatic IBC (cT4d) diagnosed 2010-2014 were identified in the National Cancer Data Base. Cox proportional hazards modeling was used to estimate the association between extent of axillary surgery (≤ 9 vs ≥ 10 LNs removed) and OS after adjusting for covariates, including post-NACT nodal status (ypN0 vs ypN1-3) and radiotherapy receipt (yes/no).

RESULTS:

3471 patients were included: 597 (17.2%) had cN0 disease, 1833 (52.8%) had cN1 disease, and 1041 (30%) had cN2-3 disease. 49.9% of cN0 patients were confirmed to be ypN0 on post-NACT surgical pathology. Being ypN0 (vs ypN1-3) was associated with improved adjusted OS for all patients. Radiotherapy was associated with improved adjusted OS for cN1 and cN2-3 patients but not for cN0 patients. Regardless of ypN status, there was a trend towards improved adjusted OS with having ≥ 10 (vs ≤ 9) LNs removed for cN2-3 patients (HR 0.78, 95% CI 0.60-1.01, p = 0.06) but not for cN0 patients (p = 0.83).

CONCLUSIONS:

A majority of IBC patients in our study presented with node-positive disease, and for those presenting with cN2-3 disease, more extensive axillary surgery is potentially associated with improved survival. For cN0 patients, however, more extensive axillary surgery was not associated with a survival benefit, suggesting an opportunity for more personalized care.

KEYWORDS:

Axillary lymph node dissection; Inflammatory breast cancer; Neoadjuvant; Pathologic complete response; Sentinel lymph node biopsy; Targeted axillary dissection

PMID:
31960171
DOI:
10.1007/s10549-020-05529-1

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