Abstract:
BACKGROUND:American College of Surgeons Oncology Group Z0011 confirms the safety of omitting axillary lymph node dissection (ALND) and regional nodal irradiation (RNI) in breast cancer patients with one to two positive sentinel lymph nodes (SLNs), without compromising disease-free survival (DFS) and overall survival (OS). In contrast, the NCIC MA20 trial showed improved DFS in node-positive patients undergoing ALND and RNI. We sought to examine how these data have influenced the management of patients with limited nodal burden. METHODS:Using the National Cancer Database, patients diagnosed between 2010 and 2015 and who met the criteria for Z0011 were identified. Logistic regression was used to analyze factors associated with practice patterns. The Cox proportional hazards model was used to assess the association of ALND and RNI with OS. RESULTS:Omission of ALND in Z0011-eligible patients reached 89.2% in 2015. This Z0011-compliant group was more likely to undergo RNI compared with the non-compliant group (36.4% vs. 31.3%; p < 0.05), with RNI increasing to 43.8% by 2015. Factors associated with the use of RNI included later year of diagnosis [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.6-2.1], hormone receptor-negative tumor (OR 1.2, 95% CI 1.1-1.4), grade 3 tumor (OR 1.2, 95% CI 1.1-1.3), treatment at a non-academic site (OR 1.2, 95% CI 1.1-1.3) and two versus one positive SLN (OR 2.0, 95% CI 1.8-2.2). With 43 months median follow-up, RNI was not associated with improved OS. CONCLUSION:Since the publication of Z0011, the omission of ALND has become widespread; however nearly half of these women now receive RNI. The optimal radiation therapy approach for this low nodal burden population warrants further study.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Raber BM,Lin H,Shen Y,Shaitelman SF,Bedrosian Idoi
10.1245/s10434-019-07901-ysubject
Has Abstractpub_date
2019-12-01 00:00:00pages
4346-4354issue
13eissn
1068-9265issn
1534-4681pii
10.1245/s10434-019-07901-yjournal_volume
26pub_type
杂志文章abstract:BACKGROUND:Several studies have proven that neoadjuvant endocrine therapy (NET) has a similar beneficial therapeutic effect in estrogen-positive (ER+) breast cancer (BC) with improved breast conservation rate in patients undergoing NET versus neoadjuvant chemotherapy (NAC). The impact of axillary complete pathologic re...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-020-08905-9
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:High-grade (HG) mucinous appendiceal neoplasms (MAN) have a worse prognosis than low-grade histology. Our objective was to assess the safety and efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) in patients with high-grade, high-volume (HG-HV) peritoneal metastase...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-4838-z
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Despite the widespread use of the sentinel lymph node biopsy technique, many patients with invasive breast cancer still undergo an axillary lymph node dissection and are at risk of arm lymphedema. With the new awareness of lymphatic spread in the axillary nodes, it should be possible to define a new surgical...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-007-9450-4
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Routine cross-sectional imaging for staging of early-stage cutaneous melanoma is not recommended. This study sought to investigate the use of imaging for staging of cutaneous melanoma in the United States. METHODS:Patients with nonmetastatic cutaneous melanoma newly diagnosed between 2000 and 2007 were iden...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-4268-3
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:The transcription factor NF-E2-related factor 2 (Nrf2) was originally identified to be a critical regulator of intracellular antioxidants and phase II detoxification enzymes. Recent studies have shown that high Nrf2 expression gives cancer cells an advantage for survival from anticancer chemotherapy and radi...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3600-2
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:The ToGA trial demonstrated the significant efficacy of trastuzumab in addition to chemotherapy in patients with HER2-positive gastric cancer (GC). Although trastuzumab has become a key drug in breast cancer treatment, resistance to trastuzumab is a major problem in clinical practice. The aim of the current ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3325-7
更新日期:2014-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:There is increasing evidence that tumor hypoxia plays a significant role in the chemoresistance of melanoma, but to our knowledge, real-time tumor oxygenation during isolated limb infusion (ILI) has not been studied. We sought to demonstrate the feasibility of measuring real-time alterations in tissue oxygen...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3222-0
更新日期:2014-05-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02303831
更新日期:1998-10-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-016-5605-5
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Fine-needle aspiration biopsy (FNAB) of the thyroid categorized as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a newly defined category according to the recent Bethesda guidelines. We sought to assess the characteristics and treatment of patients with an A...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2013-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3245-6
更新日期:2014-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-010-1490-5
更新日期:2011-04-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-006-9148-z
更新日期:2007-02-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/s10434-999-0088-2
更新日期:1999-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-016-5292-2
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Breast reconstruction following mastectomy has been shown to have a salutary effect on the overall psychological well-being of women being treated for breast cancer. Unfortunately, however, not every patient is an ideal candidate for reconstruction. Complications stemming from reconstructive surgery can caus...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/s10434-001-0586-3
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:We evaluated the use and efficacy of adjuvant chemotherapy after resection of T1-2N1M0 non-small cell lung cancer (NSCLC) in elderly patients. METHODS:Factors associated with the use of adjuvant chemotherapy in patients older than 65 years of age who underwent surgical resection of T1-2N1M0 NSCLC without in...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-4056-0
更新日期:2015-02-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2011-07-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究
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更新日期:2011-08-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2008-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究
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更新日期:2019-09-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2010-03-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/ASO.2005.11.027
更新日期:2005-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,评审
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更新日期:2020-11-11 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-016-5554-z
更新日期:2016-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2015-05-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Repeat sentinel lymph node biopsy (rSLNB) has increasingly been used in patients with ipsilateral breast tumor recurrence (IBTR). The safety in terms of regional disease control after this procedure remains unclear. This study evaluates occurrence of regional recurrence as first event in patients with IBTR a...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Although the American Joint Committee on Cancer (AJCC) classification is the most accepted lymph node (LN) staging system for gallbladder adenocarcinoma (GBA), other LN prognostic schemes have been proposed. This study sought to define the performance of the AJCC LN staging system relative to the number of m...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究
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更新日期:2016-09-01 00:00:00