How important is the axillary nodal status for adjuvant treatment decisions at a breast cancer multidisciplinary tumor board? A survival analysis.
BACKGROUND
Tumor board recommendations for breast cancer are mainly based on patient characteristics and prognostic tumor parameters. In the era of potential avoidance of axillary surgery we evaluate the impact of pathologic nodal status for adjuvant treatment decisions.


METHODS
Postoperative tumor board records of 207 patients over a 1-year period were rediscussed without knowledge of pathologic nodal status. Differences were classified as major (chemotherapy and/or radiotherapy: present/absent) or minor (different chemotherapeutic protocols) discrepancies. The survival rates among subgroups were calculated using Adjuvant! Online tool.


RESULTS
The tumor board without information of pathologic nodal status resulted in treatment changes in 72 of the 207 patients studied (34.8%). Major discrepancies were observed in 37 patients (17.9%). The survival rates were not significantly different due to a balanced overtreatment and undertreatment in this subgroup. Lymphovascular invasion (LVI) was an independent parameter used to predict the subgroup with major discrepancies (P = .001; RR = 4.9 [95% CI, 1.9-12.7]).


CONCLUSIONS
The knowledge of pathologic nodal status is important for postoperative chemotherapy and postmastectomy radiotherapy indications. There is a risk for one-third of all patients when avoiding axillary surgery to get an adjuvant therapy that differs from the current guidelines especially in carcinomas with present LVI.
Reimer
Toralf
T
Department of Obstetrics and Gynecology, University of Rostock, Klinikum Suedstadt, Suedring 81, 18059 Rostock, Germany. toralf.reimer@med.uni-rostock.de
Fietkau
Rainer
R
Markmann
Susanne
S
Stachs
Angrit
A
Gerber
Bernd
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis