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Current Oncology
Volume 27
Issue 5
10.3747/co.27.6515
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Nodal Staging Affects Adjuvant Treatment Choices in Elderly Patients with Clinically Node-Negative, Estrogen Receptor–Positive Breast Cancer

by
A. Laws
1,
R. Cheifetz
2,
R. Warburton
2,3,
C.E. McGahan
4,
J.S. Pao
3,
U. Kuusk
3,
C. Dingee
3,
M.L. Quan
1 and
E. McKevitt
2,3,*
1
Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
2
Department of Surgery, BC Cancer, University of British Columbia, Vancouver, BC, Canada
3
Department of Surgery, Providence Health Care, University of British Columbia, Vancouver, BC, Canada
4
Population Oncology, BC Cancer, Vancouver, BC, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2020, 27(5), 250-256; https://doi.org/10.3747/co.27.6515
Submission received: 11 July 2020 / Revised: 9 August 2020 / Accepted: 5 September 2020 / Published: 1 October 2020

Abstract

Background: In response to Choosing Wisely recommendations that sentinel lymph node biopsy (slnb) should not be routinely performed in elderly patients with node-negative (cN0), estrogen receptor–positive (er+) breast cancer, we sought to evaluate how nodal staging affects adjuvant treatment in this population. Methods: From a prospective database, we identified patients 70 or more years of age with cN0 breast cancer treated with surgery for er+ her2-negative invasive disease during 2012–2016. We determined rates of, and factors associated with, nodal positivity (pN+), and compared the use of adjuvant radiation (rt) and systemic therapy by nodal status. Results: Of 364 patients who met the inclusion criteria, 331 (91%) underwent slnb, with 75 (23%) being pN+. Axillary node dissection was performed in 11 patients (3%). On multivariate analysis, tumour size was the only factor associated with pN+ (p = 0.007). Nodal positivity rates were 0%, 13%, 23%, 33%, and 27% for lesions preoperatively sized at 0–0.5 cm, 0.5–1 cm, 1.1–2.0 cm, 2.1–5.0 cm, and more than 5.0 cm. Compared with patients assessed as node-negative, those who were pN+ were more likely to receive axillary rt (lumpectomy: 53% vs. 1%, p < 0.001; mastectomy: 43% vs. 2%, p < 0.001), and adjuvant systemic therapy (endocrine: 82% vs. 69%; chemotherapy plus endocrine: 7% vs. 2%, p = 0.002). Conclusions: Of elderly patients with cN0 er+ breast cancer, 23% were pN+ on slnb. Size was the primary predictor of nodal status, and yet significant rates of nodal positivity were observed even in tumours preoperatively sized at 1 cm or less. The use of rt and systemic adjuvant therapies differed by nodal status, although the long-term oncologic implications require further investigation. Multidisciplinary input on a case-by-case basis should be considered before omission of slnb.
Keywords: breast cancer in elderly patients; sentinel lymph node biopsy; predictors of nodal positivity; adjuvant radiation; adjuvant endocrine therapy breast cancer in elderly patients; sentinel lymph node biopsy; predictors of nodal positivity; adjuvant radiation; adjuvant endocrine therapy

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MDPI and ACS Style

Laws, A.; Cheifetz, R.; Warburton, R.; McGahan, C.E.; Pao, J.S.; Kuusk, U.; Dingee, C.; Quan, M.L.; McKevitt, E. Nodal Staging Affects Adjuvant Treatment Choices in Elderly Patients with Clinically Node-Negative, Estrogen Receptor–Positive Breast Cancer. Curr. Oncol. 2020, 27, 250-256. https://doi.org/10.3747/co.27.6515

AMA Style

Laws A, Cheifetz R, Warburton R, McGahan CE, Pao JS, Kuusk U, Dingee C, Quan ML, McKevitt E. Nodal Staging Affects Adjuvant Treatment Choices in Elderly Patients with Clinically Node-Negative, Estrogen Receptor–Positive Breast Cancer. Current Oncology. 2020; 27(5):250-256. https://doi.org/10.3747/co.27.6515

Chicago/Turabian Style

Laws, A., R. Cheifetz, R. Warburton, C.E. McGahan, J.S. Pao, U. Kuusk, C. Dingee, M.L. Quan, and E. McKevitt. 2020. "Nodal Staging Affects Adjuvant Treatment Choices in Elderly Patients with Clinically Node-Negative, Estrogen Receptor–Positive Breast Cancer" Current Oncology 27, no. 5: 250-256. https://doi.org/10.3747/co.27.6515

APA Style

Laws, A., Cheifetz, R., Warburton, R., McGahan, C. E., Pao, J. S., Kuusk, U., Dingee, C., Quan, M. L., & McKevitt, E. (2020). Nodal Staging Affects Adjuvant Treatment Choices in Elderly Patients with Clinically Node-Negative, Estrogen Receptor–Positive Breast Cancer. Current Oncology, 27(5), 250-256. https://doi.org/10.3747/co.27.6515

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