Top

Published in:

01-12-2015 | Original Scientific Report

Predicting Non-sentinel Lymph Node Metastasis in a Chinese Breast Cancer Population with 1–2 Positive Sentinel Nodes: Development and Assessment of a New Predictive Nomogram

Authors: Jia-ying Chen, Jia-jian Chen, Jing-yan Xue, Ying Chen, Guang-yu Liu, Qi-xia Han, Wen-tao Yang, Zhen-zhou Shen, Zhi-min Shao, Jiong Wu

Published in: World Journal of Surgery | Issue 12/2015

Abstract

Background

We have developed a new nomogram to predict the probability of a patient with 1–2 metastatic sentinel lymph nodes (SLNs) to present further axillary disease.

Methods

Data were collected from 480 patients who were diagnosed with 1–2 positive lymph nodes and thus underwent axillary lymph node dissection between March 2005 and June 2011. Clinical and pathological features of the patients were assessed with multivariable logistic regression. The Shanghai Cancer Center Non-SLN nomogram (SCC-NSLN) was created from the logistic regression model. This new model was subsequently applied to 481 patients from July 2011 to December 2013. The predictive accuracy of the SCC-NSLN nomogram was measured by calculating the area under the receiver operating characteristic curve (AUC).

Results

Based on the results of the univariate analysis, the variables that were significantly associated with the incidence of non-SLN metastasis in an SLN-positive patient included lymphovascular invasion, neural invasion, the number of positive SLNs, the number of negative SLNs, and the size of SLN metastasis (P < 0.05). Using multivariate analysis, lymphovascular invasion, the number of positive SLNs, the number of negative SLNs, and the size of SLN metastasis were identified as independent predictors of non-SLN metastasis. The SCC-NSLN nomogram was then developed using these four variables. The new model was accurate and discriminating on both the modeling and validation groups (AUC: 0.7788 vs 0.7953). The false-negative rates of the SCC-NSLN nomogram were 3.54 and 9.29 % for the predicted probability cut-off points of 10 and 15 % when applied to patients who have 1–2 positive SLNs.

Conclusion

The SCC-NSLN nomogram could serve as an acceptable clinical tool in clinical discussions with patients. The omission of ALND might be possible if the probability of non-SLN involvement is <10 and <15 % in accordance with the acceptable risk determined by medical staff and patients.

Krag DN, Anderson SJ, Julian TB et al (2007) Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 8:881–888CrossRefPubMed

Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609CrossRefPubMed

Veronesi U, Paganelli G, Viale G et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7:983–990CrossRefPubMed

Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP, Duffy SW (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23:4312–4321CrossRefPubMed

Veronesi U, Paganelli G, Galimberti V et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349:1864–1867CrossRefPubMed

Giuliano AE, Jones RC, Brennan M, Statman R (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15:2345–2350PubMed

Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 339:941–946CrossRefPubMed

Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347(8):567–575CrossRefPubMed

Orr RK (1999) The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol 6(1):109–116CrossRefPubMed

10.

Clarke M, Collins R, Darby S et al (2005) Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106CrossRefPubMed

11.

Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22(8):1736–1747PubMedCentralCrossRefPubMed

12.

Del Bianco P, Zavagno G, Burelli P et al (2008) Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella–GIVOM Italian randomised clinical trial. EJSO. 34:508–513CrossRefPubMed

13.

Carlson RW, Allred DC, Anderson BO et al (2009) Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 7:122–192PubMed

14.

Galimberti V, Cole BF, Zurrida S et al (2013) Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 14(4):297–305PubMedCentralCrossRefPubMed

15.

Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305(6):569–575CrossRefPubMed

16.

Lyman GH, Temin S, Edge SB et al (2014) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 32(13):1365–1383CrossRefPubMed

17.

Fan L, Zheng Y, Yu KD et al (2009) Breast cancer in a transitional society over 18 years: trends and present status in Shanghai. China. Breast Cancer Res Treat. 117(2):409–416CrossRefPubMed

18.

Guenther JM, Hansen NM, DiFronzo LA et al (2003) Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg 138(1):52–56CrossRefPubMed

19.

Yi M, Giordano SH, Meric-Bernstam F et al (2010) Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. Ann Surg Oncol 17(Suppl 3):343–351PubMedCentralCrossRefPubMed

20.

van Wely BJ, Teerenstra S, Schinagl DA et al (2011) Systematic review of the effect of external beam radiation therapy to the breast on axillary recurrence after negative sentinel lymph node biopsy. Br J Surg 98(3):326–333CrossRefPubMed

21.

American Cancer Society (2007) Breast cancer facts and figures 2007–2008. American Cancer Society Inc, Atlanta

22.

Chen JY, Chen JJ, Yang BL et al (2012) Predicting sentinel lymph node metastasis in a Chinese breast cancer population: assessment of an existing nomogram and a new predictive nomogram. Breast Cancer Res Treat 135(3):839–848CrossRefPubMed

23.

Katz A, Smith BL, Golshan M et al (2008) Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. J Clin Oncol 26(13):2093–2098CrossRefPubMed

24.

Van Zee KJ, Manasseh DM, Bevilacqua JL et al (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10(10):1140–1151CrossRefPubMed

25.

Lyman GH, Giuliano AE, Somerfield MR et al (2005) The American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early Stage Breast Cancer. J Clin Oncol 23(30):7703–7720CrossRefPubMed

26.

Rutgers EJ (2008) Sentinel node biopsy: interpretation and management of patients with immunohistochemistrypositive sentinel nodes and those with micrometastases. J Clin Oncol 26(5):698–702CrossRefPubMed

27.

Fant JS, Grant MD, Knox SM et al (2003) Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol 10(2):126–130CrossRefPubMed

28.

Guenther JM, Hansen NM, DiFronzo LA et al (2003) Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg 138(1):52–56CrossRefPubMed

29.

Hwang RF, Gonzalez-Angulo AM, Yi M et al (2007) Low locoregional failure rates in selected breast cancer patients with tumor-positive sentinel lymph nodes who do not undergo completion axillary dissection. Cancer 110(4):723–730CrossRefPubMed

30.

Jeruss JS, Winchester DJ, Sener SF et al (2005) Axillary recurrence after sentinel node biopsy. Ann Surg Oncol 12(1):34–40CrossRefPubMed

31.

Langer I, Marti WR, Guller U et al (2005) Axillary recurrence rate in breast cancer patients with negative sentinel lymph node(SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg 241(1):152–158PubMedCentralPubMed

32.

Naik AM, Fey J, Gemignani M et al (2004) The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg 240(3):462–468PubMedCentralCrossRefPubMed

33.

Poirier E, Sideris L, Dubé P et al (2008) Analysis of clinical applicability of the breast cancer nomogram for positive sentinel lymph node: the canadian experience. Ann Surg Oncol 15(9):2562–2567CrossRefPubMed

Title: Predicting Non-sentinel Lymph Node Metastasis in a Chinese Breast Cancer Population with 1–2 Positive Sentinel Nodes: Development and Assessment of a New Predictive Nomogram
Authors: Jia-ying Chen
Jia-jian Chen
Jing-yan Xue
Ying Chen
Guang-yu Liu
Qi-xia Han
Wen-tao Yang
Zhen-zhou Shen
Zhi-min Shao
Jiong Wu
Publication date: 01-12-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 12/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3189-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predicting Non-sentinel Lymph Node Metastasis in a Chinese Breast Cancer Population with 1–2 Positive Sentinel Nodes: Development and Assessment of a New Predictive Nomogram

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2015

Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study

Can Positive Resection Margin of Intra-hepatic Cholangiocarcinoma Still Provide a Survival Benefit over Systemic Chemotherapy?

What are the True Advantages of Devices for Hepatic Parenchymal Transection in Open Surgery?

A Bedside Risk Calculator to Preoperatively Distinguish Follicular Thyroid Carcinoma from Follicular Variant of Papillary Thyroid Carcinoma

Preoperative Sequential Portal and Hepatic Vein Embolization in Patients with Hepatobiliary Malignancy

Prognostic Impact of Distribution of Lymph Node Metastases in Stage III Colon Cancer