Giacomo Montagna1,2,3, Yiwei Tong4, Mathilde Ritter2, Jeremy Levi5, Walter P Weber2,3, Xiaosong Chen6, Kunwei Shen4. 1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 2. Breast Center, University Hospital of Basel, Basel, Switzerland. 3. University of Basel, Basel, Switzerland. 4. Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. Biometrical Practice BIOP, Basel, Switzerland. 6. Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, chenxiaosong0156@hotmail.com.
Abstract
BACKGROUND: Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. METHODS: Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. RESULTS: A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2- tumors, 38% of HR+/HER2+ tumors, 49% of HR-/HER2+ tumors, and 42% of HR-/HER2-tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2- [referent]: OR 3.42, 95% CI 1.43-8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85-9.50, p = 0.001 for HR-/HER2+; and OR 2.94, 95% CI 1.11-7.74, p = 0.029 for HR-/HER2-), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29-36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09-39.18, p = 0.003). CONCLUSION: This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.
BACKGROUND: Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. METHODS: Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. RESULTS: A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2- tumors, 38% of HR+/HER2+ tumors, 49% of HR-/HER2+ tumors, and 42% of HR-/HER2-tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2- [referent]: OR 3.42, 95% CI 1.43-8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85-9.50, p = 0.001 for HR-/HER2+; and OR 2.94, 95% CI 1.11-7.74, p = 0.029 for HR-/HER2-), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29-36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09-39.18, p = 0.003). CONCLUSION: This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.
Authors: Audree B Tadros; Wei T Yang; Savitri Krishnamurthy; Gaiane M Rauch; Benjamin D Smith; Vicente Valero; Dalliah M Black; Anthony Lucci; Abigail S Caudle; Sarah M DeSnyder; Mediget Teshome; Carlos H Barcenas; Makesha Miggins; Beatriz E Adrada; Tanya Moseley; Rosa F Hwang; Kelly K Hunt; Henry M Kuerer Journal: JAMA Surg Date: 2017-07-01 Impact factor: 14.766
Authors: Sanaz Samiei; Thiemo J A van Nijnatten; Linda de Munck; Kristien B M I Keymeulen; Janine M Simons; Loes F S Kooreman; Sabine Siesling; Marc B I Lobbes; Marjolein L Smidt Journal: Ann Surg Date: 2020-03 Impact factor: 12.969
Authors: B Fisher; A Brown; E Mamounas; S Wieand; A Robidoux; R G Margolese; A B Cruz; E R Fisher; D L Wickerham; N Wolmark; A DeCillis; J L Hoehn; A W Lees; N V Dimitrov Journal: J Clin Oncol Date: 1997-07 Impact factor: 44.544
Authors: Guido Henke; Michael Knauer; Karin Ribi; Stefanie Hayoz; Marie-Aline Gérard; Thomas Ruhstaller; Daniel R Zwahlen; Simone Muenst; Markus Ackerknecht; Hanne Hawle; Florian Fitzal; Michael Gnant; Zoltan Mátrai; Bettina Ballardini; Andreas Gyr; Christian Kurzeder; Walter P Weber Journal: Trials Date: 2018-12-04 Impact factor: 2.279