The feasibility of the ACOSOG Z0011 Criteria to Chinese Breast Cancer Patients: A Multicenter Study.

Miao Liu,Xuening Duan,Xuening Duan,Shude Cui,Shu Wang,Shu Wang,Zhigang Yu,Zhimin Fan,Zhimin Fan

doi:10.1038/srep15241

Abstract

The aim of this study was to determine the feasibility of the Z0011 criteria to Chinese breast cancer patients. An survey about the Z0011 trial was distributed and we collected 658 consecutive patients with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy from five centers’ databases and grouped them as eligible or ineligible for omitting ALND according to the Z0011 criteria. The eligible group was compared with the cohort included in the Z0011 trial and with the ineligible group. Of the 427 respondants, 106 (24.8%) and 130 (30.4%)would not routinely perform ALND in patients meeting Z0011 criteria before and after learning of the trial results, respectively. Among the 658 patients, 151 (22.9%) were eligible and 507 were ineligible for omitting ALND. The clinicopathologic factors were not statistically different between the eligible group and the Z0011 cohort. Compared with the eligible Group, the ineligible group had significantly more T2 and T3 stage tumors, positive lymph nodes(LNs) and positive non-sentinel lymph nodes (NSLNs) (P < 0.01). The findings suggest good exportability of the Z0011 criteria to Chinese patients omitting ALND, but application of Z0011 as national treatment guideline still needs additional time and effort.

Highlights

Several surveys conducted by researchers in the United States revealed that many surgeons were likely to incorporate Z0011 into their practice[7,8] and several centers have already modified their practice based on the Z0011 criteria[9,10]
Prior to publication of Z0011, it had been questioned whether axillary lymph node dissection (ALND) could be omitted in selected patients with a positive SLNB
The ACOSOG Z0011 trial is the largest prospective randomized trial far, and it compares locoregional recurrence rates and survival in women with positive sentinel nodes treated with SLNB or ALND

Summary

Introduction

Several surveys conducted by researchers in the United States revealed that many surgeons were likely to incorporate Z0011 into their practice[7,8] and several centers have already modified their practice based on the Z0011 criteria[9,10]. One of our previous studies has shown that western non-sentinel lymph node (NSLN) metastasis predicting nomogram dose not perform as well as in their original studies when used in Chinese patients[11]. This is a strong evidence to support that Chinese breast cancer patients are different from western populations. The purpose of this study is to assess the impact of Z0011 on surgeons’ practices across China, analyse the clinical relevance of the Z0011 findings for Chinese breast cancer patients and eventually evaluate the feasibility of using the Z0011 criteria to omit axillary lymph node dissection after positive sentinel lymph node biopsy in Chinese breast cancer patients

Objectives

Methods

Results

Conclusion