Omission of Axillary Lymph Node Dissection is Associated with Inferior Survival in Breast Cancer Patients with Residual N1 Nodal Disease Following Neoadjuvant Chemotherapy

Almahariq, Muayad; Levitin, R.; Quinn, Thomas J.; Chen, Peter Y.; Dekhne, Nayana; Kiran, Sayee; Desai, Arti D.; Benitez, Pamela; Jawad, M.S.; Gustafson, G.; Dilworth, J.T.

doi:10.1245/s10434-020-08928-2

Cited by 53 publications

(35 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…This finding underlines the prognostic relevance of pathologic nodal status after NAC, which is consistent with recent data suggesting that sentinel node biopsy should not be routinely substituted for axillary dissection with ypN1 disease. [31] Even if the improvement of event-free survival (EFS) could not be established with pCR in clinical trial level analysis [1], many updated studies reported the correlation between pCR and DFS and OS in most subtypes regardless of the chemotherapy regimens administered. [5,32,33] A recent meta-analysis including 52 trials also demonstrated that patients with pCR after NAC had significantly better EFS (hazard ratio 0.31, 95% CI: 0.24-0.39) and had associated improved survival (hazard ratio 0.22, 95% CI: 0.15-0.31) except for the HR(+)HER2(-) subtype.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Discrepancy of Breast and Axillary Pathologic Complete Response and Outcomes in Different Subtypes of Node-positive Breast Cancer after Neoadjuvant Chemotherapy

Chen¹,

Yu²,

Chang³

et al. 2021

J. Cancer

View full text Add to dashboard Cite

Few studies have analyzed the discrepancy between breast pathologic complete response (B-pCR) and axillary node pCR (N-pCR) rates and their impact on survival outcomes in different intrinsic subtypes of early breast cancer after neoadjuvant chemotherapy (NAC). We retrospectively reviewed B-pCR, N-pCR, and total (breast and axillary node) pCR (T-pCR) after NAC to assess the discrepancy and outcomes between 2005 and 2017. A total of 968 patients diagnosed with cT1-4c, N1-2, and M0 breast cancer were enrolled in the study. The median age was 49 years and the median follow-up time was 45 months. Of these patients, 213 achieved T-pCR, 31 achieved B-pCR with axillary node pathologic non-complete response (N-non pCR), 245 achieved N-pCR with breast pathologic non-complete response (B-non pCR), and 479 achieved total (breast and axillary node) pathologic non-complete response (T-non pCR) after NAC. The highest B-pCR and N-pCR rates were found in the hormone receptor-negative, human epidermal growth factor receptor 2-positive HR(-)HER2(+) subtype, while the lowest B-pCR rate was found in the HR(+)HER2(-) subtype. The N-pCR rate was correlated to the B-pCR rate (P<0.001), but was higher than the B-pCR rate in all subtypes. The 5-year overall survival (OS) rates for patients with T-pCR, B-pCR, and N-pCR were 91.2%, 91.7%, and 91.9%, respectively. For non-pCR, non-pCR, and non-pCR, the 5-year OS rates were 73.6%, 78.9%, and 74.7%, respectively (P<0.0001). B-non pCR patients had a lower risk of recurrence than T-non pCR or N-non-pCR patients, although there were no differences in OS among them. In conclusion, the N-pCR rate was higher than the B-pCR rate after NAC in all intrinsic subtypes, and N-non pCR or T-non pCR patients had the worst outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Discrepancy of Breast and Axillary Pathologic Complete Response and Outcomes in Different Subtypes of Node-positive Breast Cancer after Neoadjuvant Chemotherapy

Chen¹,

Yu²,

Chang³

et al. 2021

J. Cancer

View full text Add to dashboard Cite

show abstract

“…40 However, this shift in clinical practice should not occur in patients with residual lymph node disease following neoadjuvant chemotherapy. 41 All these studies included patients who were treated with systemic adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Findings from The American College of Surgeons Oncology Group Z0011 Study in Axillary Management in Patients with Invasive Breast Cancer: A Cohort Study in A Brazilian Public University Hospital

Sanvido

Elias

Facina

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: To evaluate and compare overall survival and locoregional recurrence between patients with invasive breast tumors and sentinel node metastasis undergoing sentinel lymph node dissection (SLND) alone and those undergoing complete axillary lymph node dissection (ALND).Methods: In this retrospective cohort study, we reviewed medical records of all consecutive patients with primary invasive breast carcinoma who had undergone conservative surgery at a public university hospital in Brazil between 2008 and 2018. We evaluated the overall survival and the onset of locoregional recurrence using Kaplan-Meier and Cox regression analyses, respectively. Results: Overall, 97 participants underwent conservative breast surgery, 41 in the ALND group, and 56 in the SLND group. The mean age was 57.8 years. Only 17% of the patients in the ALND group had an additional biopsy-proven axillary disease, and 83% were treated with complete dissection unnecessarily. The 5-year survival rates were 80.1 and 87.5% in the SLND and ALND groups, respectively (p = 0.376). Locoregional recurrence was rare (1.8% and 7.7% in the SLND and ALND groups, respectively; p = 0.196). Intraoperative assessment was performed in 90.2% and 30.8% cases (p < 0.00001) before and after ACOSOG Z0011, respectively. Additionally, a second surgical procedure was performed in 3.8% of cases after ACOSOG Z0011 criteria adoption.Conclusions: Overall survival and locoregional recurrence were similar between the two groups. The de-escalation of ALND to SLND in women with metastasis in the sentinel lymph node treated with conservative surgery and radiotherapy is feasible even in developing countries.

show abstract

“…There is evidence showing worse DFS for ypN0(i+) and ypN1(mic) (1.9 and 2.2 times increased mortality respectively); this was true for both cN0 and cN1 disease, with the greatest impact of low volume residual nodal disease in TNBC and HER2+ cancers (89). Using NCD data, Almahariq et al showed inferior survival outcomes in ypN1 patients that underwent SLNB alone with regional nodal irradiation, with 71% 5 year OS compared with 77% in those that had ALND (122). There is still limited data on LRR rates in patients who achieve axillary pCR post NACT.…”

Section: Management Of the Axillamentioning

confidence: 99%

Neoadjuvant Chemotherapy for Breast Cancer: Moving Beyond Pathological Complete Response in the Molecular Age

Provenzano

2021

ama

View full text Add to dashboard Cite

This review focuses on neoadjuvant chemotherapy for breast cancer which introduces practical issues for pathologists, including predicting response, optimising specimen handling, size measurement and assessment of residual disease, and recent advances in management of the axilla. The role of neoadjuvant chemotherapy in breast cancer is increasing, and it has become standard of care for high risk Human Epidermal Growth Factor Receptor 2 positive and triple negative breast cancers. The benefits of the neoadjuvant approach extend beyond pathological complete response to tumour downstaging permitting conservative surgi- cal options in the breast and axilla, and assessment of response provides valuable prognostic information to enable escalation and de-escalation of adjuvant therapy to optimise oncological outcomes. Hence histopathologists play a vital role in patient management in the neoadjuvant setting. Optimal patient selection for neoadjuvant chemotherapy requires consideration of pre- treatment histopathological and molecular tumour characteristics. Post chemotherapy, tumour staging can be challenging, and changes in criteria for measurement of primary tumour and metastases in the 7th and 8th editions of the TNM have led to confu- sion amongst pathologists. This review offers practical guidance on specimen handling and measurement of lesion size. Mov- ing forwards more detailed information on degree of response will be required for adjuvant therapy decision making, and the Residual Cancer Burden is emerging as the preferred method for quantifying residual disease not just within clinical trials but in routine practice. Recent advances in management of the axilla are discussed, including the significance of minimal residual disease in the form of isolated tumour cells and micrometastases which portend a worse prognosis in the neoadjuvant setting.Conclusion. Neoadjuvant chemotherapy now forms part of routine breast cancer management, and detailed histopathological assessment and an understanding of the importance of molecular tumour biology is essential for clinical decision making.

show abstract

Omission of Axillary Lymph Node Dissection is Associated with Inferior Survival in Breast Cancer Patients with Residual N1 Nodal Disease Following Neoadjuvant Chemotherapy

Cited by 53 publications

References 25 publications

Discrepancy of Breast and Axillary Pathologic Complete Response and Outcomes in Different Subtypes of Node-positive Breast Cancer after Neoadjuvant Chemotherapy

Discrepancy of Breast and Axillary Pathologic Complete Response and Outcomes in Different Subtypes of Node-positive Breast Cancer after Neoadjuvant Chemotherapy

Implementation of the Findings from The American College of Surgeons Oncology Group Z0011 Study in Axillary Management in Patients with Invasive Breast Cancer: A Cohort Study in A Brazilian Public University Hospital

Neoadjuvant Chemotherapy for Breast Cancer: Moving Beyond Pathological Complete Response in the Molecular Age

Contact Info

Product

Resources

About