Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer—A Single Center Experience
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients and Treatment
2.2. Endpoints
2.3. Statistical Analysis
3. Results
3.1. Patient Population
3.2. Treatment
3.3. pCR According to Molecular Subtypes
3.4. Association of Clinical, Pathological, and Treatment Factors with AXpCR
3.5. Surgical Treatment
3.6. Adjuvant Radiation Therapy
3.7. Relapse-Free Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | All Patients N (%) 92 (100) | Luminal A N (%) 4 (4.3) | LumHER2− N (%) 26 (28.3) | LumHER2+ N (%) 24 (26.1) | HER2+ NonLum N (%) 17 (18.5) | Triple Neg. N (%) 21 (22.8) | p-Value |
---|---|---|---|---|---|---|---|
Age (Years) Median Range (min, max) | 50.6 (27.0–88.2) | 67.6 (35.5–75.6) | 46.6 (27.0–78.5) | 50.9 (33.0–74.6) | 55.5 (32.0–88.2) | 46.6 (38.3–87.4) | 0.428 |
Age groups n (%) 20–35 years 36–50 years 51–65 years >65 years | 5 (5.4) 40 (43.5) 26 (28.3) 21 (22.8) | 0 (0) 1 (25) 0 (0) 3 (75) | 3 (11.5) 13 (50) 7 (26.9) 3 (11.6) | 1 (4.2) 9 (37.5) 9 (37.5) 5 (20.8) | 1 (5.9) 4 (23.5) 5 (29.4) 7 (41.2) | 0 (0) 13 (61.9) 5 (23.8) 3 (14.3) | 0.097 |
Tumor stage n (%) Unknown (cT0/x) cT1 cT2 cT3 cT4 | 2 (2.2) 16 (17.4) 49 (53.3) 18 (19.5) 7 (7.6) | 0 (0) 1 (25) 1 (25) 1 (25) 1 (25) | 1 (3.8) 4 (15.4) 13 (50) 6 (23.1) 2 (7.7) | 1 (4.2) 1 (4.2) 16 (66.7) 4 (16.6) 2 (8.3) | 0 (0) 3 (17.7) 8 (47.1) 4 (23.5) 2 (11.7) | 0 (0) 7 (33.3) 11 (52.4) 3 (14.3) 0 (0) | 0.589 |
Nodal stage n (%) cN1 cN2 cN3 | 69 (75) 16 (17.4) 7 (7.6) | 3 (75) 1 (25) 0 (0) | 16 (61.5) 5 (19.2) 5 (19.2) | 19 (79.2) 4 (16.7) 1 (4.2) | 13 (76.5) 3 (17.6) 1 (5.9) | 18 (85.7) 3 (14.3) 0 (0) | 0.407 |
Grade n (%) Grade 1 Grade 2 Grade 3 Unknown | 2 (2.2) 23 (25) 48 (52.1) 19 (20.7) | 0 (0) 3 (75) 0 (0) 1 (25) | 1 (3.8) 7 (27) 15 (57.7) 3 (11.5) | 0 (0) 6 (25) 13 (54.2) 5 (20.8) | 0 (0) 3 (17.7) 9 (52.9) 5 (29.4) | 1 (4.8) 4 (19) 11 (52.4) 5 (23.8) | 0.551 |
Characteristics | All Patients N (%) 92 (100) | Luminal A N (%) 4 (4.3) | LumHER2− N (%) 26 (28.3) | LumHER2+ N (%) 24 (26.1) | HER2+ NonLum N (%) 17 (18.5) | Triple Neg. N (%) 21 (22.8) | p-Value |
---|---|---|---|---|---|---|---|
Neoadj. Cht No 1 A→Tax TCb A→TCb Tax Capecitabine A 2 | 1 (1.1) 39 (42.4) 24 (26.1) 20 (21.7) 4 (4.3) 3 (3.3) 1 (1.1) | 0 (0) 2 (50) 0 (0) 1 (25) 1 (25) 0 (0) 0 (0) | 0 (0) 21 (80.9) 1 (3.8) 3 (11.5) 0 (0) 1 (3.8) 0 (0) | 0 (0) 9 (37.5) 12 (50) 1 (4.2) 0 (0) 2 (8.3) 0 (0) | 1 (5.9) 5 (29.4) 8 (47.1) 0 (0) 2 (8.3) 0 (0) 1 (5.9) | 0 (0) 2 (9.5) 3 (14.3) 15 (71.4) 1 (4.8) 0 (0) 0 (0) | <0.001 |
Neoadjuvant antiHER2 th. No T TP | 52 (56.5) 8 (8.7) 32 (34.8) | 4 (100) 0 (0) 0 (0) | 26 (100) 0 (0) 0 (0) | 0 (0) 4 (16.7) 20 (83.3) | 1 (5.9) 2 4 (23.5) 12 (70.6) | 21 (100) 0 (0) 0 (0) | <0.001 |
Neo/adjuvant ICI No Yes | 88 (95.7) 4 (4.3) | 4 (100) 0 (0) | 26 (100) 0 (0) | 24 (100) 0 (0) | 17 (100) 0 (0) | 17 (81) 4 (19) | 0.007 |
Surgery of breast Mastectomy BCS | 40 (43.5) 52 (56.5) | 3 (75) 1 (25) | 9 (34.6) 17 (65.4) | 8 (33.3) 16 (66.7) | 9 (52.9) 8 (47.1) | 11 (52.4) 10 (47.6) | 0.314 |
Surgery of axilla SLNB SLNB + TAS ALND | 33 (35.9) 16 (17.4) 43 (46.7) | 1 (25) 1 (25) 2 (25) | 7 (26.9) 5 (19.2) 14 (53.8) | 7 (29.2) 4 (16.7) 13 (54.2) | 10 (58.5) 3 (17.6) 4 (23.5) | 8 (38.1) 3 (14.3) 10 (23.5) | 0.604 |
Adjuvant RT No Yes | 23 (23.9) 69 (75) | 0 (0) 4 (100) | 2 (7.7) 24 (92.3) | 3 (12.5) 21 (87.5) | 10 (58.8) 7 (41.2) | 8 (38.1) 13 (61.9) | 0.002 |
Adjuvant Cht No Yes | 84 (91.3) 8 (8.7) | 3 (75) 1 (25) | 25 (96.2) 1 (3.8) | 22 (91.7) 2 (8.3) | 16 (94.1) 1 (5.9) | 18 (85.7) 3 (14.3) | 0.540 |
Adj. antiHER2 th. No T TP T-DM1 | 51 (55.4) 20 (21.7) 15 (16.3) 6 (6.5) | 4 (100) 0 (0) 0 (0) 0 (0) | 26 (100) 0 (0) 0 (0) 0 (0) | 0 (0) 12 (50) 6 (25) 6 (25) | 0 (0) 8 (47.1) 9 (52.9) 0 (0) | 21 (0) 0 (0) 0 (0) 0 (0) | <0.001 |
Adjuvant ET No Tamoxifen AI | 39 (42.4) 7 (7.6) 46 (50) | 0 (0) 0 (0) 4 (100) | 0 (0) 3 (11.5) 23 (88.5) | 1 (4.2) 4 (16.7) 19 (79.1) | 17 (100) 0 (0) 0 (0) | 21 (100) 0 (0) 0 (0) | <0.001 |
Characteristics | No AXpCR N (%) | AX-pCR N (%) | p-Value |
---|---|---|---|
Tumor stage cT1/T2 cT3/T4 | 28 (43.1) 14 (56) | 37 (56.9) 10 (44) | 0.271 |
Tumor grade Grade I Grade II Grade III Unknown | 2 (100) 15 (65.2) 18 (37.5) 9 (47.4) | 0 (0) 8 (34.5) 30 (62.5) 10 (52.6) | 0.056 |
Nodal stage n cN1 cN2/3 | 35 (45.5) 9 (60) | 42 (54.5) 6 (40) | 0.302 |
Chemotherapy Polychemotherapy Single-agent | 39 (47) 4 (50) | 44 (53) 4 (50) | 0.579 |
Anti-HER2 th. No Yes | 30 (57.7) 14 (35) | 22 (42.3) 26 (75) | 0.031 |
Subtype Lum A Lum HER2− Lum HER2+ HER2+ non-Lum TN | 4 (100) 17 (64.5) 10 (41.7) 4 (23.5) 9 (42.9) | 0 (0) 9 (34.6) 14 (58.3) 13 (76.5) 12 (57.1) | 0.013 |
Breast-pCR No Yes | 13 (27.7) 35 (77.8) | 34 (72.3) 10 (22.2) | <0.0001 |
Variable | OR (95% CI) | p-Value |
---|---|---|
Clinical tumor stage cT3/T4 vs. cT1/T2 | 0.10 (0.015–0.83) | 0.033 |
Molecular subtype HER2+ (Lum + non Lum)/TN vs. Lum A/Lum HER2− | 11.24 (1.18–107.10) | 0.036 |
Clinical nodal stage cN2/3 and cN1 | 0.23 (0.03–1.58) | 0.146 |
Variable | HR (95% CI) | p-Value |
---|---|---|
Type of breast surgery (mastectomy vs. BCS) | 0.36 (0.10–1.30) | 0.119 |
Type of axillary surgery | ||
ALND | 1.00 | 0.290 |
SLNB vs. ALND | 0.31 (0.07–1.40) | 0.126 |
SLNB + TAS vs. ALND | 0.55 (0.07–4.40) | 0.576 |
Adjuvant radiation (yes vs. no) | 0.76 (0.23–2.46) | 0.641 |
Adjuvant endocrine therapy (yes vs. no) | 0.56 (0.31–1.03) | 0.063 |
Adjuvant antiHER2 therapy (yes vs. no) | 0.61 (0.44–1.97) | 0.735 |
Molecular subtype (HER2+/TN vs. Lum A/Lum HER2−) | 1.50 (0.46–4.89) | 0.505 |
pCR in breast (yes vs. no) | 0.24 (0.05–1.08) | 0.062 |
pCR in axilla (yes vs. no) | 0.18 (0.04–0.80) | 0.024 |
Total pCR (yes vs. no) | 0.19 (0.03–1.47) | 0.112 |
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Grašič Kuhar, C.; Geiger, J.; Schwab, F.D.; Heinzelmann-Schwartz, V.; Vetter, M.; Weber, W.P.; Kurzeder, C. Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer—A Single Center Experience. Cancers 2024, 16, 1306. https://doi.org/10.3390/cancers16071306
Grašič Kuhar C, Geiger J, Schwab FD, Heinzelmann-Schwartz V, Vetter M, Weber WP, Kurzeder C. Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer—A Single Center Experience. Cancers. 2024; 16(7):1306. https://doi.org/10.3390/cancers16071306
Chicago/Turabian StyleGrašič Kuhar, Cvetka, James Geiger, Fabienne Dominique Schwab, Viola Heinzelmann-Schwartz, Marcus Vetter, Walter Paul Weber, and Christian Kurzeder. 2024. "Prognostic Importance of Axillary Lymph Node Response to Neoadjuvant Systemic Therapy on Axillary Surgery in Breast Cancer—A Single Center Experience" Cancers 16, no. 7: 1306. https://doi.org/10.3390/cancers16071306