Search

Introduction Targeted axillary dissection (TAD) after neoadjuvant chemotherapy (NAC) is a new axillary staging technique that consists of surgical removal of biopsy-proven, positive, clipped axillary nodes (CLN) in addition to the sentinel lymph node biopsy (SLNB), and provides for more conservative axillary surgery1. A question was recently raised whether clipping a positive node for later assessment indeed leads to a management change2. The purpose of our study is to report the feasibility of TAD and to evaluate false negative rate (FNR), impact on surgical ad oncological management. Materials and methods This retrospective, single-institution, study included 73 consecutive women operated between 2019 and 2021 after NAC for cN+ disease confirmed by citology or histology, whose diseased lymph-node was marked with a clip before therapy. At surgery, in case of clinical-radiological complete response, patients underwent TAD (dual mapping with radiocolloid and blue dye + CLN) (n=43), or TAD plus ALND if any residual disease (n=30). The chemoterapeutsic regimen were antracycline/taxane based, with trastuzumab in case of HER2+ tumors. Patients were routinely evaluated with a breast MRI both before and after NAC. Results Clinical and pathological details of the 73 enrolled patients are listed in Table 1. The mean age at diagnosis was 49.53±10 years. Pathologic complete response was achievied in 32 out 73 patients (43.8%) with the greatest rate in HR-/HER2+ tumors (n=10/12; 83.3%). The identification rate of the CLN was 91.8% (68/73), and it was one of SLNs in 68.5% (50/73) of the cases. In cases in which one, two or three or more SLNs were identified, the CLN was in the SLN specimen in 42.9%, 77.8% and 81.8% of cases, respectively. The FNR of the SLN was 18.5% (CI: 4.9-38.1). In 18 cases the CLN was not in the SLN specimen; eleven out of 18 CLNs were positive, leading to ALND, and three of them had additional positive LNs. Only in one case the CLN was negative and the SLN was positive. In 3 cases (4.1%), the CLN was positive in the absence of residual tumour in the breast leading a potential change in the oncological management. Conclusions Removal of CLN after NAC is feasible, allowing de-escalation of surgical management of cN+ women in case of clinical-radiological complete response, as 59% of women avoided a formal ALND. The CLN coincides with SLN in about 70% of cases (more than 80% if three or more SLNs are identified) and reflects the overall status of the axilla in 97.3% of the cases. Adding CLN to SLNB contributes to reduce significantly the FNR of the latter from 18% to 0% (FNR for SLNB =18.5% vs FNR for TAD=0%). Potential changes in surgical (CLN+/SLNs-) and oncological management (CLN+/SLNs- and absence of residual tumor in breast) occurs in 15.1% (11/73) and 4.1% (3/73) of cases, respectively. References 1. Swarnkar PK et al. The Evolving Role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) after Neoadjuvant Chemotherapy (NACT) for Node-Positive Breast Cancer: Systematic Review and Pooled Analysis. Cancers (Basel) 2021 Mar 26;13(7):1539. 2. Weiss A et al. How Often Does Retrieval of a Clipped Lymph Node Change Adjuvant Therapy Recommendations? A Prospective, Consecutive, Patient Cohort Study. 2022 Jun. Ann Surg Oncol 2022; 29(6): 3764-3771. Table 1: Clinicopathologic characteristics in the cN+ breast cancer patients NAC and clipped Lymph Node NAC Citation Format: Francesca Arienzo, Domenico Campagna, Paola Scavinia, Laura Broglia, Laura Broglia, Alessandra Ascarelli, Helena Colavito, Mirko Montanari, Elena Manna, Tiziana Mastropietro, Emanuele Zarba Meli, Massimo La Pinta, Daniela Musio, Mauro Minelli, Paola Scavina, Michelina Maria Carla Amato, Leopoldo Costarelli. Clipped lymph nodes for cN+ patients decrease false negative rate and lead to potential changes in surgical and oncological management after clinical complete response following neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-27.

Background In a changing healthcare landscape, more work needs to be done to explicate challenges with access to quality breast health care and to identify areas in need of process and quality improvement. Continuing its mission to eliminate disparities in breast cancer care, the Metropolitan Chicago Breast Cancer Task Force is focusing its efforts on structural and quality issues, with the goal of identifying gaps in care and processes in order to help low-resource facilities to implement practices aimed at delivering quality care for all. Toward this end, the Task Force is continuing its study of breast cancer care processes in institutions in the Chicago area. The aim of this study is describe the current breast healthcare landscape in Chicago and to explore the related care processes and resources for patients undergoing breast cancer screening, diagnosis, and/or treatment, including precision medicine. This study identifies breast care practices and variations in care processes amenable to quality improvement (QI) interventions. This iteration of our care process study includes an additional focus on changes following the implementation of the Patient Protection and Affordable Care Act (ACA), Illinois Medicaid reform and expansion of Medicaid eligibility. There are three aims to this study: Objective 1: Explore each institution’s current breast care processes across the disease trajectory, including screening, diagnosis, treatment and supportive care, with an emphasis on patients covered under Medicaid. Objective 2: Benchmark and analyze breast care processes across de-identified institutions with the end goal of producing and disseminating a summary report. Objective 3: Evaluate the feasibility of quality improvement initiatives to address care process improvements in low-resource sites, with an assessment of outcomes pre- and post- intervention. Methods The study will utilize three surveys that will be distributed to all participating facilities via the Qualtrics survey platform. The surveys are as follows: • Medicaid Managed Care Survey This survey contains questions related to how Illinois’ Medicaid managed care system has impacted the facility. • Environmental Scan Screening/Diagnosis Survey This survey contains questions related to the facility’s processes around mammography screening, timeframes, communication with patients and providers, diagnostic processes, radiology practices, biopsy and pathology practices and patient satisfaction. • Environmental Scan Treatment Survey The treatment survey contains specialty-specific questions (e.g., pathology, radiologist, surgeon, etc.) which will require responses from different individuals knowledgeable in these areas. Participating facilities will receive an individualized report comparing facility data with aggregated data. In addition, an aggregated report will be developed. Results Preliminary study results should be available in late summer/early fall. Available results will be reported in the poster. Citation Format: Carla Amato-Martz, Anne Marie Murphy. Breast cancer screening, diagnostic and/or treatment care processes in care institutions in the Chicago area [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B115.

ObjectiveOlder patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort.Materials and methodsWe randomly selected 9001 patients with surgically resected stage I-III NSCLC in 2006-2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression.ResultsMedian age at initial diagnosis was 67; 69.7% had >1 comorbidity. At 5-year follow-up, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age >75 compared with 75 compared with

6519 Background: Comprehensive assessment of comorbidity in cancer registries is critical for comparative effectiveness research. The National Cancer Database (NCDB) measures comorbidity with a diagnosis code-based Charlson Comorbidity Index (CCI) abstracted from discharge abstracts or billing face sheets. However, the prognostic performance of this code-based CCI has not been compared with a medical chart-based CCI or individual comorbid conditions in a nationally representative sample of patients with lung cancer. Methods: Through a special study of the NCDB, cancer registrars performed chart abstraction for 18 perioperative comorbid conditions for 9,640 randomly selected patients with stage I-III non-small cell lung cancer resected in 2006-07 at 1,150 Commission on Cancer-accredited facilities. We compared the prognostic performance of the NCDB code-based categorical CCI (0, 1, 2+), special study chart-based continuous CCI, and individual comorbid conditions in 3 separate Cox proportional hazards models for 5-year postoperative overall survival. All models adjusted for demographic and clinical characteristics. Results: Median age was 67 (IQR 60-74). The most common comorbidities were COPD (40%) and CAD (21%). Five-year postoperative overall survival was 55.5%. Agreement between the code- and chart-based CCIs was 51.9% with the code-based CCI underestimating comorbidity for 36.2% patients. The model including individual comorbid conditions had the best prognostic performance (R2 0.196, C index 0.654). COPD, CAD, CHF, dementia, diabetes, moderate/severe renal and liver disease, peripheral vascular disease, psychiatric disorder, and substance abuse were independently associated with decreased survival. The chart-based CCI model (R2 0.189, C index 0.650) predicted postoperative survival better than the code-based CCI model (R2 0.181, C index 0.645). Conclusions: The NCDB code-based CCI underestimates comorbidity in patients with surgically resected lung cancer. The chart-based CCI and data on individual comorbid conditions improved prognostic performance and would be valuable additions to the NCDB to strengthen comparative effectiveness research.