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Luminal A Versus B After Choosing Wisely: Does Lymph Node Surgery Affect Oncologic Outcomes?
Cynthia Ong1, Christian M Blue1, Jamal Khan1
1School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Annals of Surgical Oncology
|October 13, 2023
Summary
Sentinel lymph node biopsy (SLNB) did not improve outcomes for older women with luminal B breast cancer. Omitting SLNB may be safe for these patients, as outcomes depend more on tumor biology and patient factors.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Choosing Wisely campaign advised against routine sentinel lymph node biopsy (SLNB) for older women (≥70) with early-stage HR+, HER2- breast cancer.
- Luminal B breast cancer is more aggressive than Luminal A, yet current guidelines do not differentiate between them for SLNB recommendations.
Purpose of the Study:
- To evaluate the impact of SLNB on oncologic outcomes in elderly women (≥70) with HER2-negative, hormone receptor-positive breast cancer, specifically comparing Luminal B and Luminal A subtypes.
- To determine if SLNB offers survival benefits in Luminal B versus Luminal A breast cancer.
Main Methods:
- Retrospective cohort study of women aged ≥70 with clinically node-negative, HR+ breast cancer from 2010-2020.
- Luminal status determined by gene expression, Ki67, and/or grading.
- Primary endpoints: locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS).
Main Results:
- SLNB showed no significant difference in LRR for either Luminal A or Luminal B disease.
- SLNB correlated with improved DFS and OS in Luminal A disease, but not in Luminal B disease.
- Multivariate analysis indicated age and tumor size affected DFS, while Luminal status, age, and comorbidities affected OS, with SLNB not being a significant factor.
Conclusions:
- SLNB can likely be omitted in patients aged ≥70 with Luminal B breast cancer, as LRR is similar to Luminal A.
- Disease-free survival and overall survival in this patient group are primarily influenced by tumor biology, patient age, and comorbidities, not the use of SLNB.
