Olga Kantor1,2, Melia Wakeman2, Anna Weiss1,2, Stephanie Wong3, Alison Laws1,2, Samantha Grossmith1,2, Elizabeth A Mittendorf1,2, Tari A King4,5. 1. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 2. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02215, USA. 3. McGill University Health Centre, Montreal, QC, Canada. 4. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. tking7@bwh.harvard.edu. 5. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02215, USA. tking7@bwh.harvard.edu.
Abstract
BACKGROUND: Data to guide axillary management after neoadjuvant endocrine therapy (NET) remain limited. METHODS: We analyzed type of axillary surgery [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and residual nodal disease burden after NET in two cohorts of patients with cT1-4N0-1M0 hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer: Dana-Farber/Brigham and Women's Cancer Center (DFBWCC) cohort (2015-2018) and the National Cancer Data Base (NCDB) cohort (2012-2016). Cox proportional hazard regression was used to determine adjusted 5-year overall survival (OS) by type of axillary surgery. RESULTS: Ninety-four (4.3%) of 2191 HR+/HER2- DFBWCC patients and 4363 (1.5%) of 283,344 NCDB patients were selected for NET. Of those who underwent axillary surgery, 30 (43.5%) in the DFBWCC cohort and 1583 (40.6%) in the NCDB cohort had ALND. Over 90% of cN0 patients in both cohorts had fewer than three positive nodes on final pathology [44 (95.7%) DFBWCC and 2945 (91.3%) NCDB]. In contrast, only 7 (30.4%) DFBWCC patients and 342 (50.7%) NCDB cN1 patients had fewer than three positive nodes. In the DFBWCC patients, there were no locoregional recurrences and four distant recurrences. In the NCDB, 5-year OS did not differ by type of axillary surgery regardless of residual nodal disease burden: 96.6% SLNB versus 97.9% ALND for 0 positive nodes; 84.4% versus 84.4% for one to two positive nodes, and 75.9% versus 77.3% for three or more positive nodes (all p > 0.10). CONCLUSIONS: In cN0 patients selected for NET, > 90% have fewer than three positive nodes at surgery. The lack of a survival difference between SLNB and ALND suggests an opportunity to de-escalate treatment of the axilla in patients with limited residual nodal disease.
BACKGROUND: Data to guide axillary management after neoadjuvant endocrine therapy (NET) remain limited. METHODS: We analyzed type of axillary surgery [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and residual nodal disease burden after NET in two cohorts of patients with cT1-4N0-1M0 hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer: Dana-Farber/Brigham and Women's Cancer Center (DFBWCC) cohort (2015-2018) and the National Cancer Data Base (NCDB) cohort (2012-2016). Cox proportional hazard regression was used to determine adjusted 5-year overall survival (OS) by type of axillary surgery. RESULTS: Ninety-four (4.3%) of 2191 HR+/HER2- DFBWCC patients and 4363 (1.5%) of 283,344 NCDB patients were selected for NET. Of those who underwent axillary surgery, 30 (43.5%) in the DFBWCC cohort and 1583 (40.6%) in the NCDB cohort had ALND. Over 90% of cN0 patients in both cohorts had fewer than three positive nodes on final pathology [44 (95.7%) DFBWCC and 2945 (91.3%) NCDB]. In contrast, only 7 (30.4%) DFBWCC patients and 342 (50.7%) NCDB cN1patients had fewer than three positive nodes. In the DFBWCC patients, there were no locoregional recurrences and four distant recurrences. In the NCDB, 5-year OS did not differ by type of axillary surgery regardless of residual nodal disease burden: 96.6% SLNB versus 97.9% ALND for 0 positive nodes; 84.4% versus 84.4% for one to two positive nodes, and 75.9% versus 77.3% for three or more positive nodes (all p > 0.10). CONCLUSIONS: In cN0 patients selected for NET, > 90% have fewer than three positive nodes at surgery. The lack of a survival difference between SLNB and ALND suggests an opportunity to de-escalate treatment of the axilla in patients with limited residual nodal disease.
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Authors: Covadonga Martí; Laura Yébenes; José María Oliver; Elisa Moreno; Laura Frías; Alberto Berjón; Adolfo Loayza; Marcos Meléndez; María José Roca; Vicenta Córdoba; David Hardisson; María Ángeles Rodríguez; José Ignacio Sánchez-Méndez Journal: Curr Oncol Date: 2022-03-23 Impact factor: 3.109