ACOSOG Z0010: A multicenter prognostic study of sentinel node (SN) and bone marrow (BM) micrometastases in women with clinical T1/T2 N0 M0 breast cancer

  • Background:
    • Sentinel node (SN) biopsy (SNB) with immunohistochemistry (IHC) of histologically negative SN:
      • Identifies metastases not seen by standard histology
    • The impact of IHC-detected BM metastasis:
      • Has been reported in several large single-institution studies
    • 5,539 patients were entered into this prospective multicenter observational study:
      • To determine the clinical significance of SN and BM mets
  • Methods:
    • Patients underwent lumpectomy and SNB with bilateral iliac crest BM aspiration
    • BM and histologically negative SN were evaluated:
      • With IHC in a central laboratory (results not clinically reported)
    • Overall survival (OS), disease-free survival, and locoregional recurrence were determined
    • Results with OS (the primary endpoint) are shown here
  • Results:
    • SN were successfully identified:
      • In 5,184 of 5,485 pts:
        • 94.5%
    • Histologic SN mets were found:
      • In 1,239 pts:
        • 23.9%
    • IHC detected:
      • An additional 350 pts (10.5%) with SN metastasis
      • BM metastasis were identified by IHC:
        • In 105 of 3491 examined (3.0%)
    • 5-yr overall survival is shown in the Table
    • BM IHC positivity:
      • Significantly predicted:
        • Decreased OS (p=0.015)
    • A multivariable analysis that included:
      • SN and BM status, ER, PR, grade, size, and age:
        • Showed that neither IHC detected metastasis in SN (p=0.66) or BM (p=0.08):
          • Were independent predictors of OS:
            • Although BM status showed a strong trend
  • Conclusions:
    • The detection of BM metastasis by IHC in patients with clinical T1 to T2, N0, M0 breast cancer:
      • Identifies those patients at significantly increased risk for death
    • The impact of BM metastasis on outcome:
      • Supports and confirms prior studies
    • In this study:
      • SN IHC-detected metastasis:
        • Appear to have no significant impact on OS
      • The routine examination of SN by IHC:
        • Is not supported in this patient population by this study
5-year OS by SN and BM status

#Arrangoiz #BreastSurgeon #BreastCancer #CancerSurgeon #SurgicalOncologist

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