Axiller lenf nodu pozitif meme kanserinde non-sentinel lenf nodu pozitifliğine etki eden faktörler ve nomogramların etkinliğinin karşılaştırılması

Yıl 2018, , 397 - 406, 13.12.2018

Bülent Koca , Bekir Kuru

https://doi.org/10.5798/dicletip.497892

Öz

Amaç: Amacımız aksiller lenf nodu pozitif meme kanserinde
nonsentinel lenf nodu (NSLN) pozitifliğine etki eden faktörleri araştırmak ve
hasta grubumuzda Memorial Sloan-Kettering Cancer Center (MSKCC) ve Stanford
nomogramlarının etkinliğini karşılaştırmaktır.

Yöntemler: 01.01.2008 - 31.08.2011 tarihleri arasında
Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği’nde sentinel
lenf nodu biyopsisi (SLNB) sonucunda sentinel lenf nodunda metastaz saptanan invaziv
meme kanseri olan 112 hasta çalışmaya alındı. Karşılaştırılacak değişkenler
SPSS 15.0 versiyonu programından yararlanılarak kaydedildi. Lojistik regresyon
analizi ile NSLN pozitifliğine etki eden risk faktörleri araştırıldı. P<
0.05 anlamlılık düzeyi olarak kabul edildi. Her iki nomogram icin “Receiver
Operating Characteristics (ROC)” eğrileri oluşturuldu ve eğriler altındaki
alanlar(AUC) hesaplandı. AUC değeri 0.70 ve üzerinde hesaplanan yöntem etkin
olarak kabul edildi.

Bulgular: Tek değişkenli analizde tümör boyutu,
multifokalite, lenfovasküler invazyon varlığı, SLN’daki metastazın
makrometastaz oluşu, SLN’da kapsül dışı invazyon varlığı ve metastatik SLN
sayısının toplam SLN sayısına oranı anlamlı bulundu. Çok değişkenli analizde
lenfovasküler invazyon, SLN’da kapsül dışı invazyon ve metastatik SLN sayısının
toplam SLN sayısına oranı NSLN metastazı ile ilgili bağımsız prediktif
faktörler olarak saptandı. MSKCC ve Stanford nomogramlarının ikisinin de hasta
grubumuzda etkin olmakla birlikte MSKCC nomogramının daha etkin olduğu sonucuna
vardık.

Sonuç: Nomogramlar aksillada NSLN’unda metastataz olasılığı
hakkında yol gösterici yöntemlerdir. Ancak henüz aksiller lenf nodu
diseksiyonunun (ALND) yerini alacak kapasitede değildirler. NSLN pozitifliğine
etki eden yeni prediktif faktörlerin ortaya konulması ile etkinlikleri
artırılabilir. Her klinik kendisine en uygun nomogramı belirlemeli ve kullanmalı
veya kendi nomogramını oluşturmalıdır.

Anahtar Kelimeler

Meme kanseri, Non-sentinel lenf nodu pozitifliği

Kaynakça

• 1. Baring CC, Squires TS, Tang T. Cancer Statistics 1993. CA Cancer J Clin 1993; 43: 4-26.
• 2. Silvenberg E, Lubera J, Cancer Statistics 1987, CA Cancer J Clin 1987; 37: 19-24.
• 3. Greenlee RT, Murray T, Bolden S, et al. Cancer Statistics 2000. CA Cancer Clin 2000; 50: 7-33.
• 4. Dees EC, Lawrence N, Souba WW, et al. Does Information From Axillary Dissection Change Treatment In Clinically Node-Negative Patients With Breast Cancer. Ann Surg 1999; 226: 279-87.
• 5. Anderson BO, Austin-Seymour M.M, Gralow JR, et al. A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer. Cancer Control 1997; 4: 491-9.
• 6. Weaver DL, Krag DN, Ashikaga T, et al. Pathologic Analysis of Sentinel and nonsentinel Lymph Nodes In Breast Carcinoma: A Multicenter Study. Cancer 2000; 88: 1099-107.
• 7. Barth R.J, Danforth DN, Venzon DJ, et al. Level of Axillary Involvement by Lymph Node Metastases From Breast Cancer is not An Independent Predictor of Survival. Arch Surg 1991;126:574-77.
• 8. Arthur Z, Krasnow H, Robert SH. Lymphocintigraphy Revisted. Nucl Med Ann 1999; 76: 17-96.
• 9. Krag DN. Minimal Access Surgery for Staging Regional Lymph Nodes: The Sentinel Node Concept. Curr Probl Surg 1998; 35: 951-18.
• 10. Brenin DR, Morrow M, Moughan J, et al. Manegement Of Axillary Lymph Node In Breast Cancer: A National patterns of Care Study of 17,151 Patients. Ann Surg 1999; 230: 686-91.
• 11. Veronesi U, Paganelli G,Viale G. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Eng J Med 2003; 349: 546-53.
• 12. Van Zee KJ, Manasseh D, Bevilacqua J, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel lymph node biopsy. Ann Surg Oncol 2003; 10: 1140–51.
• 13. Gur AS, Unal B, Ozbek U, et al. Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study. Eur J Surg Oncol 2010; 36: 30-5.
• 14. Kell MR, Burke JP, Barry M, et al. Outcome of axillary staging in early breast cancer: a meta-analysis. Breast Cancer Res Treat 2010; 120: 441-7.
• 15. Veronesi U, Viale G, Paganelli G, et al. Sentinel lymph node biopsy in breast cancer: Ten-year results of a randomized controlled study. Ann Surg 2010; 251: 595-600.
• 16. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005; 23: 7703-20.
• 17. Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 1999; 229: 536-41.
• 18. Weir L, Speers C, D’yachkova Y, et al. Prognostic significance of the number of axillary lymph nodes removed in patients with mode negative breast cancer. J Clin Oncol 2002; 20: 1793–9.
• 19. Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer 1977; 39: 2827-39.
• 20. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compare with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11: 927-33.
• 21. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15- year survival: an overview of the randomised trials. Lancet 2005; 365: 1687-717.
• 22. Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg 2004; 187: 69-72.
• 23. Latosinsky S, Dabbs K, Moffat F. Canadian Association of General Surgeons and American College of Surgeons Evidence-Based Reviews in Surgery. 27. Quality-of-life outcomes with sentinel node biopsy versus standard axillary treatment in patients with operable breast cancer. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. Can J Surg 2008; 51: 483-5.
• 24. Travagli JP, Atallah D, Mathieu MC, et al. Sentinel lymphadenectomy without systematic axillary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasis Eur J Surg Oncol 2003; 29: 403-6.
• 25. Sachdev U, Murphy K, Derzie A, et al. Predictors of nonsentinel lymph node metastasis inbreast cancer patients. Am J Surg 2002; 183: 213–7.
• 26. Bolster MJ, Peer PGM, Bult P, et al. Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study. Ann Surg Oncol 2007; 14: 181-9.
• 27. Schrenk P, Konstantiniuk P, Wölfl S. Prediction of non-sentinel lymph node status in breast cancer with a micrometastatic sentinel node. Br J Surg 2005; 92: 707-13.
• 28. Zhang T, Wang H, Chen B, et al. Risk factors for non-sentinel lymph node metastases in breastcancer patients with positive sentinel lymph nodes. Chinese Med J 2008; 121: 2107-9.
• 29. Kapur U, Rubinas T, Ghai R, et al. Prediction of nonsentinel lymph node metastasis in sentinel node-pozitive breast carcinoma. Ann of Diagn Pathol 2007; 11: 10-12.
• 30. Stitzenberg KB, Meyer AA, Stern SL, et al. Extracapsular extension of the sentinel lymph node metasases: a prediction of nonsentinel node tumor burden. Ann Surg 2003; 237: 607-12.
• 31. Park J, Park KM, Park JM, et al. Predicting Factors of Nonsentinel Lymph Node Metastasis in Breast Cancer Patients with Sentinel Lymph Node Metastasis. J Korean Surg Soc 2010; 79: 20-26.
• 32. Reynolds C, Mick R, Donohue JH et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol 1999; 17: 1720-6.
• 33. Van Iterson V, Leidenius M. Krogerus L, et al. Predictive factors for the status of non-sentinel nodes in breast cancer patients with tumor positive sentinel nodes. Breast Cancer Research and Treatment 2003; 82: 39-45.
• 34. Mignotte H, Treilleux I, Faure C, et al. Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol 2002; 28: 623-5.
• 35. Cserni G: Sentinel lymph-node biopsy-based prediction of further breast cancer metastases in the axilla. Eur J Surg Oncol 2001; 27: 532-8.
• 36. Fougo JL, Afonso M, Senhorães Senra F. Predictive factors for non-sentinel lymph node involvement in breast cancer patients with a positive sentinel node: should we consider sentinel node-related factors? Clin Transl Oncol 2009; 11: 165-71.
• 37. Meretoja TJ, Strien L, Heikkilä PS, et al. A Simple Nomogram to Evaluate the Risk of Nonsentinel Node Metastases in Breast Cancer Patients with Minimal Sentinel Node Involvement. Ann Surg Oncol 2011; 27: 112-7.
• 38. Langer I, Marti WR, Guller U, et al. Axillary recurence rate in breast cancer patients with negative sentinel lymph node(SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg 2005; 241: 152-8.
• 39. Chagpar A, Middleton LP, Saghin AA, et al. Clinical outcome of patients with lymph node-negative breast carcinoma who have sentinel lymph node micrometastases detected by immunohistochemistry. Cancer 2005; 103: 1581-6.
• 40. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 2011; 305: 569-75.
• 41. Lambert L, Hunt KK, Hwang RF, et al. Validation of a breast cancer nomogram for predicting additional nodal metastases after positive sentinel node biopsy. Ann Surg Oncol 2005; 12: 17-21.
• 42. Soni NK, Carmalt HL, Gillette DJ, et al. Evaluation of a breast cancer nomogram for prediction of nonsentinel lymph node positivity. Eur J Sur Oncol 2005; 9: 958-64.
• 43. Degnim A, Reynolds C, Newman LA, et al. Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg 2005; 190: 543–50.
• 44. Smidt ML, Kuster M, Strobbe LJA, et al. Can the Memorial Sloan-Hettering Cancer Center nomogram predict the likelihood of nonsentinel lymph node metastases in breast cancer patients in the Netherlands? Ann Surg Oncol 2005; 12: 1066-72.
• 45. Arlan S, De Rycke Y, Fourchotte V, et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol 2007; 14: 2195-201.
• 46. Kocsis L, Svebis M, Cserni G, et al. Use and limitations of a nomogram predicting the likelihood of non-sentinel node involvement after a positive sentinel node biopsy in breast cancer patients. Am Surg 2004; 70: 1019-24.
• 47. Klar M, Jochmann A, Foeldi M, et al. The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population. Breast Cancer Res Treat 2008; 112: 523-31
• 48. Gür AS, Ünal B, Johnson R, et al. The predictive probability of different breast cancer Nomograms for non sentinel axillary lymph node metastasis in Positive sentinel lymph node biopsy. Meme Sağlığı Dergisi 2008:4:169-73.
• 49. Hessman CJ, Naik AM, Kearney NM,et al. Comparative validation of online nomograms for predicting nonsentinel lymph node status in sentinel lymph node- positive breast cancer. Arch Surg 2011; 146: 1035-40.
• 50. Moghaddam Y, Falzon M, Fulford L, et al. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg 2010; 97: 1646-52.
• 51. Hidar S, Harrabi I, Benregaya L,et al. Validation of nomograms to predict the risk of non-sentinels lymph node metastases in North African Tunisian breast cancer patients with sentinel node involvement. Breast 2011; 20: 26-30.