Hanyang University Hospital team says domestic breast cancer lymph node dissection requires selective implementation

Hanyang University Hospital team says domestic breast cancer lymph node dissection requires selective implementation

July 19,2022

- The team of Professor Chi-hwan Cha published in the prestigious publication, World Journal of Surgical Oncology

The Korean Breast Cancer Society's examination of big data revealed that the frequency of underarm lymph node dissection, which removes a major number of lymph nodes, is still greater among Korean breast cancer patients than in Europe.

These findings were published in the most recent issue of the World Journal of Surgical Oncology by the team of Professor Chi-Hwan Cha of Surgery at Hanyang University Hospital (corresponding author: Prof. Min-Sung Jung; the thesis is "Impact of the ACOSOG Z0011 trial on surgical practice in Asian patients: trends in axillary surgery for breast cancer from a Korean Breast Cancer Registry analysis")

Traditional breast cancer surgery removes a substantial amount of axillary lymph concurrently with breast surgery. The 2010 study “Z0011” by the Society of Surgical Oncology in the United States, however, noted that even if one or two metastatic lymph nodes were found in a breast cancer patient, if appropriate adjuvant treatment was administered, it has been elucidated that there was no issue with recurrence or survival if lymph node dissection was not performed. The incidence of underarm lymph node dissection has been reduced dramatically in the United States and Europe since the results were disclosed, but no relevant study results have yet been published in Asian nations.

Using information from the Korean Breast Cancer Society's large-scale registration project, Professor Cha's team analyzed big data on 7,500 patients who underwent partial mastectomy in Korea from 2011 to 2018 and examined the most recent trends in armpit surgery. In consequence, the percentage of lymph node dissections decreased considerably from 76.6 percent in 2011 to 47.5 percent in 2018. In addition, the decrease rate of lymph node dissection was six times slower than that of the Dutch cohort (2011-2015, 4,900 participants), which recently released the findings of a large-scale study (annual rate of change in Korea and the Netherlands: 5.8% vs. 37.2%, p 0.001). In Korea in particular, it was shown that axillary lymph node dissection was conducted more frequently when the tumor had been identified before, when the tumor was considerable in size, when the tumor was a triple-negative subtype, or when lymphatic vascular metastasis was present.

Professor Chi-hwan Cha said, "This is the first Asian report using big data to examine the trend of axillary lymph node surgery. There is a need for more research since the features of Asians, who have an abundance of triple-negative subtypes, are not reflected. If all armpit lymph nodes are removed by dissection, lymphedema may develop in the arm, and motor and sensory function may deteriorate, resulting in a decline in quality of life. Lymph node dissection should be undertaken judiciously and with caution."

*Triple-negative subtype: Triple-negative (subtype) breast cancer is a subtype of breast cancer in which both estrogen receptor (ER), progesterone receptor (PR), and HER2 expression are negative in immunohistochemical staining. This subtype accounts for 15 to 20 percent of breast cancers.

 

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