Her2 positive and triple negative breast cancer patients with clinically negative nodes at diagnosis and breast pathologic complete response may spare axillary surgery after neoadjuvant treatment

Siso, Christian; Esgueva, Antonio; Rodríguez, Roberto; Espinosa, Marta; Córdoba, Octavi; Rubio, IT

doi:10.1016/s0959-8049(18)30288-0

Cited by 4 publications

(5 citation statements)

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“…Our study also found that the rates of ypN0 in patients with HR+/HER2−, HR+/HER2+, HR−/HER2+, and TN breast cancer were 75.4% (46/61), 82.6% (19/23), 81.5% (22/27), and 97.2% (36/37), respectively ( P < 0.001). No ALNs metastasis (0/31) was found in all patients who achieved bpCR after NAC, which was similar to the results of Tadros et al and Siso et al Our study showed that the rate of ypN0 in cN0 patients was 83.1%, especially in patients with HER2+ (with targeted therapy, 95.5%) and TN (94.6%), making it possible to selectively avoid axillary surgery after NAC, which would contribute to reduce postoperative complications, improve patient quality of life, and reduce medical costs.…”

Section: Discussionsupporting

confidence: 89%

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

et al. 2019

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This study aimed to explore the optimal time of sentinel lymph node biopsy (SLNB) and neo‐adjuvant chemotherapy (NAC) and to assess the feasibility of selective elimination of axillary surgery after NAC in clinically node‐negative (cN0) patients. From April 2010 to August 2018, 845 patients undergoing surgery after NAC were included in this retrospective study to analyze the correlation between different clinicopathological characteristics of cN0 patients and negative axillary lymph node after NAC (ypN0). Among the 148 cN0 patients, 83.1% (123/148) were ypN0. The rates of ypN0 in patients with hormone receptor positive (HR+)/HER2−, HR+/HER2+, HR−/HER2+, and triple‐negative (TN) breast cancer were 75.4% (46/61), 82.6% (19/23), 85.2% (23/27), and 94.6% (35/37), respectively (P < 0.001). The rates of ypN0 in TN and HER2+ patients were 94.6% and 95.5%, which were significantly higher than that in HR+/HER2− patients (P < 0.05). Molecular subtypes, clinical stage, radiologic complete response, and pathologic complete response (bpCR) of the breast tumor correlated with ypN0 after full‐course NAC (P < 0.05). Molecular subtypes (OR = 2.374, P = 0.033), clinical stage (OR = 0.320, P = 0.029), and bpCR (OR = 0.454, P = 0.012) were independent predictors for ypN0. The optimal time of SLNB and NAC in cN0 patients might be different among different molecular subtypes: it would be preferable to perform SLNB prior to NAC for HR+/HER2− patients, and SLNB after NAC for TN and HER2+ patients to reduce the risk of axillary lymph node dissection. In view of the high ypN0 rate in cN0 patients, axillary surgical staging might be selectively eliminated, especially for HER2+ and TN patients.

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Section: Discussionsupporting

confidence: 89%

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

et al. 2019

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“…The results illustrated that the risk of ALNs residual metastases of HER2+ and TN patients with cN0 after NAT was less than 2%, and axillary surgery could be considered to be avoided. Our results demonstrated that HER2+ and TN patients with cN0/1 to ycN0 and bpCR had ypN0 rate of 97.6% (40/41) after NAT, and the risk of ALNs residual metastases was low, thus making it possible to selectively eliminate axillary surgery staging after NAT, which was consistent with the results of Siso (23). Our results also illustrated that there were 2 cases of ALNs metastases in cN1 patients with bpCR after NAT, but no pathological findings of more than 3 positive ALNs metastases, suggesting that the residual metastases load of ALNs in cN1 patients with bpCR after NAT was low, and axillary surgery still could be considered to be avoided.…”

Section: Discussionsupporting

confidence: 89%

Predictive factors of pathologically node-negative disease for HER2 positive and triple-negative breast cancer after neoadjuvant therapy

et al. 2021

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Background: With the improvement of the efficacy of neoadjuvant therapy (NAT) that is guided by molecular subtypes, the rate of pathologically node-negative disease after NAT (ypN0) is increasing for HER2 positive (HER2+) and triple-negative (TN) breast cancer patients. The necessity of axillary surgery for patients with high ypN0 has been questioned. This study aimed to identify patients among HER2+ and TN breast cancer with low risk for axillary metastases after NAT, and, perhaps, they are suitable for selective elimination of axillary surgery staging. Methods: From January 2010 to August 2018, 865 breast cancer patients who underwent NAT were included in this retrospective clinical study, and 184 patients (21.3%，184/865) suffered from TN and HER2+ breast cancer and received full-course NAT. The correlation among clinicopathological characteristics of HER2+ and TN breast cancer and ypN0 were analyzed.Results: Among the 184 HER2+ and TN breast cancer patients, tumor staging, lymph node staging and Ki-67 before NAT, clinically node-negative disease after NAT (ycN0), and breast radiologic and pathologic complete response (bpCR) were correlated with ypN0 (P<0.05). Lymph node staging before NAT (OR =0.363, P<0.001), ycN0 (OR =4.995, P<0.001) and bpCR (OR =11.285, P<0.001) were the independent effects of ypN0. The ypN0 rate after NAT in cN0/1 patients with bpCR and ycN0 (97.6%, 40/41) was significantly higher than that in cN2/3 patients (62.5%, 10/16) (P<0.001). Among the 37 patients with initial nodal ultrasonography showing cN0 disease, 17 of 17 (100.0%) with and 18 of 20 (90.0%) without bpCR had no evidence of residual nodal disease (P=0.178). Among the 42 patients with cN1 to ycN0, 23 of 24 (95.8%) with and 10 of 18 (55.6%) without bpCR had no evidence of residual nodal disease (P<0.001). Patients without bpCR had a relative risk for nodal residual metastases of 10.560 (95% CI: 2.720-41.003; P<0.001) compared with those with bpCR in cN1 group. Conclusions:In terms of HER2+ and TN breast cancer patients, clinical lymph node staging before NAT, ycN0 and bpCR were the independent predictors of ypN0. bpCR was highly correlated with nodal status after NAT. The risk of axillary lymph nodes residual metastases after NAT in the patients of bpCR with cN0 and cN1 to ycN0 was less than 5%, thus making it possible to selectively avoid axillary surgery.

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“…U novijoj se literaturi spominje još nekoliko modaliteta za pomoć u kliničkoj procjeni aksilarnog odgovora na NAST; imunološki mikrookoliš tumora (viši % TILa-> manja vjerojatnost ypN(+)) 26,27 , genski test razvijen na MD Anderson Cancer Cen- ter koji u 70 % slučajeva točno predviđa odgovor limfnih čvorova na NAST 28 te nomogrami za predviđanje pCR aksile utemeljeni na dokazano najjačim prediktivnim faktorima; mlađa dob, intrinzični podtip tumora, cN status, a kao najvažniji navodi se patološki kompletan odgovor (engl. pathologic complete response, pCR) u dojci 29,30 . Izvođenje postupka TAD uz SLNB nakon NAST-a smanjuje FNR na 1.4 -7 %, međutim, pitanje je ima li smanjenje FNR-a ikakav klinički značaj?…”

Section: Aksilarna Kirurgija Nakon Neoadjuvantne Sistemske Terapijeunclassified

Aksilarna kirurgija u liječenju invazivnog karcinoma dojke

Peterko

2021

Med. Flum. (Online)

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U posljednjih nekoliko desetljeća prisutan je konstantan trend deeskalacije aksilarne kirurgije u liječenju invazivnog karcinoma dojke. Početkom stoljeća biopsija sentinel limfnog čvora postaje zlatni standard i do danas gotovo potpuno zamjenjuje aksilarnu disekciju kod liječenja ranog stadija raka dojke. Istraživanja koja su u tijeku pokušavaju utvrditi postoji li u ovoj populaciji opravdanost ikakvog kirurškog postupka u aksili. Istovremeno se šire indikacije za preoperativno sistemsko onkološko liječenje, međutim, sve do 2017. godine vrlo je konzervativan kirurški pristup u okviru neoadjuvantnog liječenja, s aksilarnom limfadenektomijom kao jedinom opcijom. Iako je biopsija limfnog čvora čuvara nakon neoadjuavntnog liječenja već tri godine preporučena svim relevantnim smjernicama za liječenje karcinoma dojke, još uvijek je prisutan velik otpor u prihvaćanju ovog koncepta u svakodnevnu kliničku praksu. Ovaj pregled je prikaz znanstveno utemeljenog razvoja smjernica u aksilarnoj kirurgiji, postojećih kontroverzi i istraživanja koja ih pokušavaju riješiti.

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Her2 positive and triple negative breast cancer patients with clinically negative nodes at diagnosis and breast pathologic complete response may spare axillary surgery after neoadjuvant treatment

Cited by 4 publications

References 0 publications

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

Neo‐adjuvant chemotherapy and axillary de‐escalation management for patients with clinically node‐negative breast cancer

Predictive factors of pathologically node-negative disease for HER2 positive and triple-negative breast cancer after neoadjuvant therapy

Aksilarna kirurgija u liječenju invazivnog karcinoma dojke

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