A.P. Davis2, X. Dong1, S. Huang3, C.S. Cortina1, A.L. Kong1, A.N. Cobb1 1Medical College Of Wisconsin, Surgical Oncology- Breast, Milwaukee, WI, USA 2Medical College Of Wisconsin, Medical Education, Milwaukee, WI, USA 3University Of Wisconsin, Zibler School Of Public Health, Milwaukee, WI, USA
Introduction: AJCC TNM staging alongside tumor receptor status informs breast cancer (BC) management which requires a multidisciplinary approach.Robust data has proposed de-escalation of nodal management for select patients with BC including omission of nodal surgery for those ≥70 years of age with early-stage clinically node-negative hormone-receptor (HR) positive HER2-negative disease.However, less is known about contemporary surgical nodal management in older patients with locally advanced BC.Thus,we aimed to describe surgical nodal management in patients age ≥70 with locally advanced BC.
Methods: The National Cancer Database (NCDB) was queried from 2017–2019 to identify women ≥70 years with Stage I-III BC. Nodal management was separated into three groups:omission, SLNB defined as removal of 1-5 nodes, and axillary lymph node dissection (ALND) defined as removal of 10 or greater nodes.Baseline patient demographic and clinicopathologic characteristics were obtained using descriptive statistics with proportions for categorical variables and means with standard deviation for continuous variables.The distribution of nodal management type for each combined clinical T and N stage was calculated by receptor status, with a focus on locally advanced (cT4N0+) cancers.
Results: Overall, there were 99,438 eligible patients.Most patients were between 70-81 years of age (77.9%),non-Hispanic white (NHW) (84.8%), and had Medicare insurance (87.8%).The bulk of patients had HR+ BC (90.9%) and underwent partial mastectomy (73.6%).The Charlson-Deyo Comorbidity score was 0 for 75.4% of patients.In patients with HR+/HER2- BC, those with cT4N0 disease omitted nodal surgery 30.1% of the time and cT4N+ disease omitted 8.4% of the time.In patients with HR+/HER2 + BC, those with cT4N0 disease omitted nodal surgery 5.1% of the time and cT4N+ disease omitted 24.1% of the time.In patients with HR-/HER2+ BC, those with cT4N0 disease omitted nodal surgery 40% of the time and cT4N+ disease omitted 28.9% of the time.In patients with HR-/HER2- BC, those with cT4N0 disease omitted nodal surgery 31.7% of the time and cT4N+ disease omitted 8.4% of the time. The rates of sentinel node biopsy and ALND by subtype can be found in Table 1.
Conclusions:Although nodal de-escalation in early-stage node negative cancers has become standard of care, omission of nodal surgery is being applied in more advanced staged cancers,including in patients with aggressive tumor biology.More research is required to elucidate the reasons behind this.