title: Predictors and outcomes of completion axillary node dissection among older breast cancer patients.
abstract: BACKGROUND
  The role of completion axillary lymph node dissection (ALND) for older women who had sentinel lymph node-positive (SLN+) invasive breast cancer is unclear. We examined factors predictive of ALND and the association between ALND, adjuvant chemotherapy administration, and survival.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we reviewed records of women age >65 diagnosed with stage I/II breast cancer from 1998-2005. Adjusted Cox proportional hazards and multivariate logistic regression were used to identify patient and disease variables associated with ALND, and assess association between ALND and all-cause and breast cancer-specific survival.
  
  
  RESULTS
  Among SLN+ patients, 88 % underwent ALND. Earlier diagnosis year, greater nodal involvement, younger age, registry location, and larger tumor size were all associated with a significantly higher likelihood of ALND. The ALND in SLN+ patients was not significantly associated with 5-year breast cancer-specific survival (hazard ratio [HR] 1.22, 95 % confidence interval [CI] 0.76-1.96). The SLN+ patients who underwent ALND were more likely to receive adjuvant chemotherapy (odds ratio [OR] 1.8, 95 % CI 1.45-2.24). However, younger age (OR 18.0, 95 % CI 14.4-23.9), estrogen receptor-negative (ER-) status (OR 4.2, 95 % CI 3.4-5.3), and fewer comorbidities (OR 2.6, 95 % CI 1.7-4.0) were all more strongly linked to receipt of chemotherapy.
  
  
  CONCLUSIONS
  ALND for older patients with SLN+ breast cancer is not associated with improved 5-year all-cause or breast cancer-specific survival. Younger age, fewer comorbidities, and estrogen receptor-negative (ER-) status were more strongly associated with receipt of chemotherapy than ALND. Consideration should be given to omitting ALND in older patients, particularly if findings of ALND will not influence adjuvant therapy decisions.
authors.affiliation: Departments of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, USA, sjavid@uw.edu.
authors.forename: Sara H
authors.initials: SH
authors.lastname: Javid
authors.forename: Hao
authors.initials: H
authors.lastname: He
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Korde
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate