Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection
Abstract
:Highlights
Simple Summary
Abstract
1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
NAC | Neoadjuvant Chemotherapy |
TAD | Targeted Axillary Dissection |
ALND | Axillary Lymph Node Dissection |
SLNB | Sentinel Lymph Node Biopsy |
FNR | False-Negative Rate |
US | Ultrasound |
RT | Radiotherapy |
HER2 | Human Epidermal Growth Factor Receptor 2 |
TNBC | Triple-Negative Breast Cancer |
References
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Total (n = 118) | ypN0 (n = 44) | ypN+ (n = 74) | OR (95% CI) | p Value | ||
---|---|---|---|---|---|---|
Age Median (range) | 55 (27, 85) | 56 (27, 78) | 54 (29, 85) | 1.01 (0.99, 1.04) | 0.344 | |
cT | T1 | 13 (11%) | 7 (54%) | 6 (46%) | 1.86 (0.43, 8.27) | 0.405 |
T2 | 48 (41%) | 12 (25%) | 36 (75%) | 6.50 (2.10, 22.3) | 0.002 | |
T3 | 17 (14%) | 6 (35%) | 11 (65%) | 3.97 (1.03, 17.0) | 0.051 | |
T4b | 18 (15%) | 4 (22%) | 14 (78%) | 7.58 (1.87, 37.0) | 0.007 | |
T4d | 19 (16%) | 13 (68%) | 6 (32%) | Ref | ||
TX | 3 (2.5%) | 2 (67%) | 1 (33%) ⌂ | NS | ||
cN | * N0/1 | 1 (0.8%) | 0 (0%) | 1 (100%) | NS | |
N1 | 93 (79%) | 38 (41%) | 55 (59%) | Ref | ||
N2 | 14 (12%) | 1 (7.1%) | 13 (93%) | 8.98 (1.68, 167) | 0.038 | |
N3 | 10 (8.5%) | 5 (50%) | 5 (50%) | 0.69 (0.18, 2.64) | 0.579 | |
Phenotype | Luminal A | 4 (3.4%) | 1 (25%) □ | 3 (75%) | 9.60 (0.99, 221) | 0.073 |
Luminal B HER2 negative | 33 (28%) | 1 (3.0%) # | 32 (97%) | 102 (15.9, 2073) | <0.001 | |
Luminal B HER2 positive | 18 (15%) | 8 (44%) | 10 (56%) | 4.00 (1.06, 16.9) | 0.047 | |
** Luminal B HER2 positive/negative | 1 (0.8%) | 0 (0%) | 1 (100%) | NS | ||
Non-luminal HER2 positive | 21 (18%) | 16 (76%) | 5 (24%) | Ref | ||
Triple-negative breast cancer | 41 (35%) | 18 (44%) | 23 (56%) | 4.09 (1.32, 14.5) | 0.019 | |
Type of breast surgery | Breast-conserving surgery | 30 (25%) | 7 (23%) | 23 (77%) | Ref | |
Mastectomy | 87 (74%) | 36 (41%) | 51 (59%) | 0.43 (0.16, 1.07) | 0.082 | |
No surgery | 1 (0.8%) | 1 (100%) | 0 (0%) | |||
ypT | ypT0 | 29 (25%) | 22 (76%) | 7 (24%) | Ref | |
ypTis | 12 (10%) | 8 (67%) | 4 (33%) | |||
ypT1 | 38 (32%) | 10 (26%) | 28 (74%) | 7.64 (2.91, 21.7) | <0.001 | |
ypT2 | 27 (23%) | 0 (0%) | 27 (100%) | 46.4 (11.6, 317) | <0.001 | |
ypT3 | 4 (3.4%) | 1 (25%) | 3 (75%) | |||
ypT4b | 5 (4.2%) | 1 (20%) | 4 (80%) | |||
X | 3 (2.5%) | 2 (67%) | 1 (33%) | NS | ||
Number of examined lymph nodes Median (range) | 12 (1, 37) | 11 (1, 37) | 12 (5, 30) | 1.07 (1.0, 1.17) | 0.086 |
Reason for ALND | Number of Cases |
---|---|
Inflammatory carcinoma | 13 (29.5%) |
Persistent pathological nodes on re-staging US examination | 8 (18.2%) |
Participation in a drug clinical trial | 6 (13.6%) |
Combination of multiple “minor” factors | 6 (13.6%) |
Locally advanced breast cancer (LABC) at initial presentation (T4bN2, T4bN1, T3N2, T3N3, T2N3) | 5 (11.4%) |
Occult carcinoma (supported by re-staging ultrasound examination) | 2 (4.5%) |
Contraindications to adjuvant radiotherapy | 2 (4.5%) |
Misinterpretation of ultrasound examination | 2 (4.5%) |
Total | 44 (100%) |
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Zapletal, O.; Žatecký, J.; Gabrielová, L.; Selingerová, I.; Holánek, M.; Burkoň, P.; Coufal, O. Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection. Cancers 2025, 17, 178. https://doi.org/10.3390/cancers17020178
Zapletal O, Žatecký J, Gabrielová L, Selingerová I, Holánek M, Burkoň P, Coufal O. Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection. Cancers. 2025; 17(2):178. https://doi.org/10.3390/cancers17020178
Chicago/Turabian StyleZapletal, Ondřej, Jan Žatecký, Lucie Gabrielová, Iveta Selingerová, Miloš Holánek, Petr Burkoň, and Oldřich Coufal. 2025. "Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection" Cancers 17, no. 2: 178. https://doi.org/10.3390/cancers17020178
APA StyleZapletal, O., Žatecký, J., Gabrielová, L., Selingerová, I., Holánek, M., Burkoň, P., & Coufal, O. (2025). Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection. Cancers, 17(2), 178. https://doi.org/10.3390/cancers17020178