Axillary Surgery in Breast Cancer Patients Treated with Breast-Conserving Surgery at German Breast Cancer Centers Within the Last 14 Years – Comparison of a University Center and a Community Hospital

Abstract

Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade.

Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U-BCC) and the community hospital Dachau (D-BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data.

Results The average annual rate of sentinel node biopsy (SNB) was 85.5% and 87.2% in Ulm and Dachau, respectively. SNB was performed more precisely at the U-BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (r_s = − 0.82; p < 0.001) and Dachau (r_s = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U-BCC (r_s = − 0.76; p = 0.002) while it remained stable in D-BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1% preZ0011 and 14.4% postZ0011; p < 0.001) in Ulm.

Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U-BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D-BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

Zusammenfassung

Hintergrund In den letzten 10 Jahren haben sich die Empfehlungen zum operativen Vorgehen in der Axilla bei Mammakarzinompatientinnen gewandelt.

Methoden Die Daten von insgesamt 5344 Patientinnen mit invasivem Brustkrebs, die sich entweder im Brustzentrum des Universitätsklinikums Ulm (U-BCC) oder im Helios Amper-Klinikum Dachau (D-BCC) einer brusterhaltenden Therapie (BET) unterzogen, wurden basierend auf den dokumentierten anonymisierten Tumorregisterdaten retrospektiv zwischen 2003 und 2016 analysiert, um neue Trends im chirurgischen Vorgehen bei Axillainterventionen zu identifizieren.

Ergebnisse Im Durchschnitt wurden pro Jahr bei 85,5% der in Ulm und 87,2% der in Dachau mittels BET behandelten Patientinnen Wächterlymphknoten-Biopsien (SNB) durchgeführt. Dabei betrug die mittlere Anzahl an entfernten Lymphknoten (LN) pro SNB in Ulm 2,4 verglichen zu 3,2 LN in Dachau. Die mediane Anzahl an entfernten LN pro Axilladissektion reduzierte sich im Verlauf des Beobachtungszeitraums sowohl in Ulm (r_s = − 0,82; p < 0,001) als auch in Dachau (r_s = − 0,76; p = 0,002). Im Laufe der Jahre nahm zudem die Rate an sekundären Axilladissektionen (nach SNB, 2° ALNE) im U-BCC signifikant ab (r_s = − 0,76; p = 0,002), wohingegen sie in D-BCC stabil blieb. Mit Veröffentlichung der Ergebnisse der Z0011-Studie im Jahr 2010 kam es in Ulm zu einem statistisch signifikanten Rückgang an sekundären ALNE (24,1% vor Z0011 und 14,4% nach Z0011; p < 0,001).

Schlussfolgerung Die jährlichen Statistiken der untersuchten Brustzentren zeigen deutliche Trends im operativen Axillastaging bei Mammakarzinompatientinnen mit BET über die letzten Jahre. Bei der Mehrheit der Patientinnen wurde eine BET mit SNB durchgeführt. Während in beiden Zentren die Zahl der durchschnittlich pro ALNE entnommenen LN über die Jahre signifikant abnahm, ging mit der Publikation der Z0011-Studie auch die Rate an sekundären ALNEs selbst in Ulm zurück. Nachdem ein derartiger Trend für das D-BCC nicht beobachtete werden konnte, kann vermutet werden, dass neue Daten schneller Einzug in die klinische Routine von universitären Brustzentren erhalten.

Key words

breast cancer - national guidelines - treatment changes - sentinel node biopsy - axillary lymph node dissection

Schlüsselwörter

Brustkrebs - nationale Richtlinien - Änderungen in der Behandlung - Wächter-Lymphknotenbiopsie - Axilladissektion

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