| Title |
Axillary Nodal Evaluation in Elderly Breast Cancer Patients: Potential Effects on Treatment Decisions and Survival
|
|---|---|
| Published in |
Annals of Surgical Oncology, July 2018
|
| DOI | 10.1245/s10434-018-6595-2 |
| Pubmed ID | |
| Authors |
Nina Tamirisa, Samantha M. Thomas, Oluwadamilola M. Fayanju, Rachel A. Greenup, Laura H. Rosenberger, Terry Hyslop, E. Shelley Hwang, Jennifer K. Plichta |
| Abstract |
Recent studies suggest that surgical lymph node (LN) evaluation may be omitted in select elderly breast cancer patients as it may not influence adjuvant therapy decisions. To evaluate differences in adjuvant therapy receipt and overall survival (OS), we compared clinically node-negative (cN0) elderly patients who did and did not undergo axillary surgery. Patients aged ≥70 years in the National Cancer Database (2004-2014) with cT1-3, cN0 breast cancer were divided into two cohorts-those with surgical LN evaluation (one or more nodes removed) and those without (no nodes removed). Propensity scores were used to match patients based on age, year of diagnosis, tumor grade, cT stage, estrogen receptor status, and Charlson-Deyo comorbidity score. A Cox proportional hazards model was used to estimate the effect of LN surgery on OS. Overall, 133,778 patients were matched, of whom 102,247 patients (76.4%) underwent nodal surgery. Patients undergoing nodal surgery were more likely to receive chemotherapy (pN1-3: 22.2%; pN0: 5.8%; cN0-no nodal surgery: 2.8%; p < 0.001), radiation (pN1-3: 49.7%; pN0: 47.5%; cN0-no nodal surgery: 26%; p < 0.001), and endocrine therapy (pN1-3: 72%; pN0: 58.5%; cN0-no nodal surgery: 46.5%; p < 0.001). After adjustment for known covariates, patients who did not undergo nodal surgery had a worse OS (hazard ratio 1.66, 95% confidence interval 1.61-1.70). For elderly cN0 breast cancer patients, axillary surgery was associated with higher rates of adjuvant therapy and improved OS. A selective approach to omitting nodal surgery should be considered in elderly patients with cN0 breast cancer as axillary staging may influence subsequent treatment decisions and long-term outcomes. |
X Demographics
The data shown below were collected from the profiles of 40 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 11 | 28% |
| Venezuela, Bolivarian Republic of | 9 | 23% |
| Spain | 2 | 5% |
| United Kingdom | 2 | 5% |
| Sweden | 2 | 5% |
| Mexico | 2 | 5% |
| Ecuador | 1 | 3% |
| Unknown | 11 | 28% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 21 | 53% |
| Practitioners (doctors, other healthcare professionals) | 9 | 23% |
| Scientists | 8 | 20% |
| Science communicators (journalists, bloggers, editors) | 2 | 5% |
Mendeley readers
The data shown below were compiled from readership statistics for 41 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 41 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 5 | 12% |
| Other | 4 | 10% |
| Student > Bachelor | 4 | 10% |
| Student > Ph. D. Student | 3 | 7% |
| Professor | 2 | 5% |
| Other | 4 | 10% |
| Unknown | 19 | 46% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 13 | 32% |
| Nursing and Health Professions | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Computer Science | 1 | 2% |
| Biochemistry, Genetics and Molecular Biology | 1 | 2% |
| Other | 4 | 10% |
| Unknown | 20 | 49% |
Attention Score in Context
This research output has an Altmetric Attention Score of 28. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 22 November 2018.
All research outputs
#1,202,778
of 23,096,849 outputs
Outputs from Annals of Surgical Oncology
#155
of 6,550 outputs
Outputs of similar age
#27,808
of 327,941 outputs
Outputs of similar age from Annals of Surgical Oncology
#12
of 126 outputs
Altmetric has tracked 23,096,849 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,550 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.4. This one has done particularly well, scoring higher than 97% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 327,941 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 126 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 90% of its contemporaries.