pN0(i+) and pN1mi Breast Cancer: Treatment and Outcomes in Comparison With pN0 and pN1a in the Modern Era

Dosani, Maryam; Hamilton, Sarah; Gondara, Lovedeep; Speers, Caroline; Diocee, Rekha M.; Nichol, Alan; Lohrisch, Caroline; Truong, Pauline T.

doi:10.1016/j.ijrobp.2022.03.029

Cited by 1 publication

(2 citation statements)

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“…One analysis of 10 271 patients undergoing locoregional radiation therapy found 10-year breast cancer-specific survival rates of 95% for patients with pN0 disease, 93% for patients with pN1mi disease, and 87% for patients with pN1a-c disease. 10 Finally, Kaplan-Meier modeling identified that while a benefit in overall survival was associated with patients aged < 50 with HR+/HER2− EBC, pN1a-c disease and RS < 26 receiving combined chemo-endocrine therapy, there was no benefit seen in those with pN1mi and pN0 disease. Our data on this large sample size corroborates post hoc analysis from RxPONDER presented as an update at the San Antonio Breast Cancer Symposium in 2021 showing a trend but no statistically significant benefit (HR 0.88, CI 0.18-1.08) to chemotherapy in premenopausal patients with RS between 0 and 25.…”

Section: Discussionmentioning

confidence: 99%

“…The classification of nodal involvement is per American Joint Committee on Cancer staging criteria: “pN1a-c” referring to metastases to 1-3 axillary lymph nodes and/or in internal mammary nodes, “pN1mi” as lymph node neoplastic deposits >0.2 but ≤2 mm, and “pN0” as neither macro- nor micrometastasis identified on pathologic specimen review. 10 …”

Section: Methodsmentioning

confidence: 99%

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Outcomes in Premenopausal Patients with HR+/HER2− Breast Cancer and Lymph Node Micrometastasis Based on the 21-Gene Recurrence Score

Bilani,

Patel,

Crowley

et al. 2023

The Oncologist

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Background Postmenopausal patients with hormone receptor positive, HER2-negative (HR+/HER2−) early breast cancer (EBC) and 21-gene OncotypeDX (ODX) recurrence scores (RS) <26 do not benefit from chemoendocrine therapy (“CET”) compared to endocrine monotherapy (“E”), regardless of nodal status. In premenopausal patients, nodal status is significant in interpretation of RS. However, guidelines are not explicit in recommendations for patients with micrometastasis (“pN1mi” staging). Methods A cohort of patients aged <50 years with HR+/HER2− EBC who underwent ODX testing was identified within the National Cancer Database 2004-2019 dataset. We confirmed the prognostic value of ODX in pN1mi disease with multivariate Cox regression for overall survival (OS). We explored how patterns of practice differed by nodal status in cases of low RS (<26) with chi-squared testing. Finally, we performed Kaplan-Meier models comparing OS for those with RS <26 receiving E versus CET, controlling for nodal status. Results Of 72 068 patients aged <50 years with HR+/HER2− EBC, 6.1% (n = 4402) had micrometastasis. Multivariate Cox regression confirmed prognostic value of ODX in this pN1mi cohort (P < .001). In the context of RS <26, CET was used most commonly in patients with 1-3 involved lymph nodes (“pN1a-c” disease), less frequently in pN1mi disease, and least in node-negative (“pN0”) disease. A benefit in OS was observed in cases with RS <26 and pN1a-c receiving CET vs. E (P = .017), but not in pN1mi (P = .49) or pN0 (P = .57) disease. Conclusion Our large registry analysis found CET was associated with improved OS in pN1a-c, but not in pN1mi or pN0 disease.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%