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Original Article |
1 Division of Surgical Oncology, University of Louisville, 315 East Broadway, Suite 312, Louisville, KY 40202, USA
2 Department of Surgery, University of Louisville, 550 South Jackson Street, 2nd Floor, Louisville, KY 40202, USA
3 Department of Radiation Oncology, University of Louisville, Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, USA
4 St. Mary’s Medical Center and Deaconess Hospital, 520 Mary Street, Suite 520, Evansville, IN 47710, USA
5 Breast Surgeons of North Texas, 7777 Forest Lane, C-614, Dallas, TX 75230, USA
6 Richardson Regional Hospital, 399 W. Campbell Road, Suite 302, Richardson, TX 75080, USA
7 Hudson Valley Surgical Associates, 117 Mary’s Avenue, Suite 201, Kingston, NY 12401, USA
8 Department of Epidemiology, Harvard School of Public Health, Kresge Building, 9th floor 677 Huntington Avenue, Boston, MA 02115, USA
Correspondence: Address correspondence and reprint requests to: Anees B. Chagpar, MD, MSc;Division of Surgical Oncology, University of Louisville, 315 East Broadway, Suite 312, Louisville, KY 40202, USA E-mail: Anees.chagpar{at}nortonhealthcare.org
Background: Postmastectomy radiation therapy (PMRT) is recommended for patients with four or more positive lymph nodes (LN+). Given the ramifications of PMRT for immediate reconstruction, we sought to create a model using preoperative and intraoperative factors to predict which patients with a positive sentinel lymph node will have less than four LN+.
Methods: The database from a prospective multicenter study of 4,131 patients was used for this analysis. Patients with one to three positive sentinel lymph nodes (SLN) and tumors < 5 cm (n = 1,133) in size were randomly divided into a training set (n = 580) and a test set (n = 553). Multivariate logistic regression was used on the training set to create a prediction rule that was subsequently validated in the test set.
Results: Median patient age was 57 (range, 27–100) years, and median tumor size was 2.0 (range, 0.2–4.8) cm. In the training set, factors associated with having four or more LN+ on multivariate analysis were: tumor size [odds ratio (OR) = 2.087; 95% confidence interval (CI): 1.307–3.333, P = 0.002), number of positive SLN (P < 0.0005), and proportion of positive SLN (OR = 3.602; 95% CI: 2.100–6.179, P < 0.005). A predictive model was established with a point assigned to each positive SLN, T2 (vs. T1), and if proportion of positive SLN was > 50%, for a maximum of five points. In both the training and test sets, patients with one point had a low probability of having four or more LN+ (3.8% and 3.3%, respectively).
Conclusion: Tumor size, number of positive SLN, and the proportion of positive SLN influence whether patients will have four or more LN+. A simple model can predict the probability of requiring PMRT.
Key Words: Lymph nodes • Breast cancer • Reconstruction • Radiation • Mastectomy
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