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Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

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Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
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National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
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Medical Clinic II, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
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Oncology Practice, Bethanien Hospital Frankfurt, Im Prüfling 17-19, 60389 Frankfurt, Germany
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Department of Radiotherapy, University Hospital Schleswig Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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Department of Senology, Rotkreuz-Klinikum, Rotkreuzplatz 8, 80634 Munich, Germany
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Institute of Pathology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany
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Breast Center, Diakovere Henriettenstift, Schwemannstraße 17, 30559 Hannover, Germany
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Department of Gynecology and Obstetrics, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany
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Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistraße 92, 45136 Essen, Germany
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Oncologic Medical Care Center Krebsheilkunde, Möllendorffstraße 52, 10367 Berlin, Germany
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Department for Women’s Health, University of Tübingen, Calwerstraße 7, 72076 Tuebingen, Germany
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Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
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Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Department of Obstetrics and Gynecology, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069 Offenbach, Germany
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Praxisklinik für Hämatologie und Onkologie Koblenz, Neversstraße 5, 56068 Koblenz, Germany
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German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany
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Department of Gynecology with Breast Center Charité, Charitéplatz 1, 10117 Berlin, Germany
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Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Department of Obstetrics and Gynecology, University of Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany
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Department of Gynecology, Klinikum Esslingen, Hirschlandstraße 97, 73730 Esslingen, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: David Wong
Cancers 2022, 14(3), 521; https://doi.org/10.3390/cancers14030521
Received: 1 December 2021 / Revised: 13 January 2022 / Accepted: 18 January 2022 / Published: 20 January 2022
The extent of axillary surgery has been reduced in recent years to minimize side effects. However, a negative impact of reduced surgery on outcome must be avoided. We investigated for whom the extent of surgery can be safely reduced by examining early-stage breast cancer patients converting from lymph node (LN)-positive to LN-negative disease after neoadjuvant systemic treatment (NAST). Of 242 initially LN-positive patients treated within the GeparOcto trial, 54.5% were classified as LN-negative after NAST, 31.8% as LN-positive, and for 13.6% data were missing. Overall, 92.1% of patients underwent complete axillary LN dissection, with 6.6% undergoing sentinel LN dissection only. At surgery, 55.4% of patients had no signs of cancer in the LN, 45.0% had no signs of cancer in the breast (of those 8.3% had involved LN), and 41.3% had no signs of cancer at all. Patients with involved LN still had a bad prognosis. Conversion from LN-positive to LN-negative after NAST is of highest prognostic value. Surgical axillary staging after NAST is essential in these patients to offer tailored treatment.
Background: The conversion of initially histologically confirmed axillary lymph node-positive (pN+) to ypN0 after neoadjuvant systemic treatment (NAST) is an important prognostic factor in breast cancer (BC) patients and may influence surgical de-escalation strategies. We aimed to determine pCR rates in lymph nodes (pCR-LN), the breast (pCR-B), and both (tpCR) in women who present with pN+ BC, to assess predictors for response and the impact of pCR-LN, pCR-B, and tpCR on invasive disease-free survival (iDFS). Methods: Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial. Results: Of 242 patients with initially pN+ disease, 134 (55.4%) had a pCR-LN, and 109 (45.0%) a pCR-B. Of the 109 pCR-B patients, 9 (8.3%) patients had involved LN, and 100 (41.3%) patients had tpCR. Those with involved LN still had a bad prognosis. As expected, pCR-B and intrinsic subtypes (TNBC and HER2+) were identified as independent predictors of pCR-LN. pCR-LN (ypN0; hazard ratio 0.42; 95%, CI 0.23–0.75; p = 0.0028 for iDFS) was the strongest independent prognostic factor. Conclusions: In initially pN+ patients undergoing NAST, the conversion to ypN0 is of high prognostic value. Surgical axillary staging after NAST is still essential in these patients to offer tailored treatment. View Full-Text
Keywords: breast cancer; neoadjuvant therapy; axillary surgery; pathological complete response; lymph node; prognosis breast cancer; neoadjuvant therapy; axillary surgery; pathological complete response; lymph node; prognosis
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MDPI and ACS Style

Gerber, B.; Schneeweiss, A.; Möbus, V.; Golatta, M.; Tesch, H.; Krug, D.; Hanusch, C.; Denkert, C.; Lübbe, K.; Heil, J.; Huober, J.; Ataseven, B.; Klare, P.; Hahn, M.; Untch, M.; Kast, K.; Jackisch, C.; Thomalla, J.; Seither, F.; Blohmer, J.-U.; Rhiem, K.; Fasching, P.A.; Nekljudova, V.; Loibl, S.; Kühn, T. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers 2022, 14, 521. https://doi.org/10.3390/cancers14030521

AMA Style

Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Hanusch C, Denkert C, Lübbe K, Heil J, Huober J, Ataseven B, Klare P, Hahn M, Untch M, Kast K, Jackisch C, Thomalla J, Seither F, Blohmer J-U, Rhiem K, Fasching PA, Nekljudova V, Loibl S, Kühn T. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers. 2022; 14(3):521. https://doi.org/10.3390/cancers14030521

Chicago/Turabian Style

Gerber, Bernd, Andreas Schneeweiss, Volker Möbus, Michael Golatta, Hans Tesch, David Krug, Claus Hanusch, Carsten Denkert, Kristina Lübbe, Jörg Heil, Jens Huober, Beyhan Ataseven, Peter Klare, Markus Hahn, Michael Untch, Karin Kast, Christian Jackisch, Jörg Thomalla, Fenja Seither, Jens-Uwe Blohmer, Kerstin Rhiem, Peter A. Fasching, Valentina Nekljudova, Sibylle Loibl, and Thorsten Kühn. 2022. "Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial" Cancers 14, no. 3: 521. https://doi.org/10.3390/cancers14030521

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