Risk scoring system for predicting axillary response after neoadjuvant chemotherapy in initially node-positive women with breast cancer

Ouldamer, Lobna; Chas, Marie; Arbion, Flavie; Body, G.; Cirier, Julien; Ballester, Marcos; Bendifallah, Sofiane; Daraı̈, Émile

doi:10.1016/j.suronc.2018.02.003

Cited by 16 publications

(27 citation statements)

References 31 publications

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“…Tadros et al 9 concluded that the risk of missing nodal metastases if surgical axillary staging is omitted is very small in patients with initial cN0 status and no residual disease in the breast, especially in the triple-negative and HER2-positive subgroups. In the light of de-escalated surgery, risk scoring systems are emerging with the aim of identifying women with the highest likelihood of nodal conversion who might be spared any axillary surgery after NAST 26 . In patients with cN0 disease and a negative SLNB after NAST, most women can now be spared an ALND.…”

Section: Discussionmentioning

confidence: 99%

Long-term prognosis in breast cancer is associated with residual disease after neoadjuvant systemic therapy but not with initial nodal status

Zetterlund

Celebioglu

Hatschek

et al. 2021

British Journal of Surgery

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Background: This follow-up analysis of a Swedish prospective multicentre trial had the primary aim to determine invasive disease-free (IDFS), breast cancer-specific (BCSS) and overall survival (OS) rates, and their association with axillary staging results before and after neoadjuvant systemic therapy for breast cancer. Methods: Women who underwent neoadjuvant systemic therapy for clinically node-positive (cN+) or-negative (cN0) primary breast cancer between 2010 and 2015 were included. Patients had a sentinel lymph node biopsy before and/or after neoadjuvant systemic therapy, and all underwent completion axillary lymph node dissection. Follow-up was until February 2019. The main outcome measures were IDFS, BCSS and OS. Univariable and multivariable Cox regression analyses were used to identify independent factors associated with survival. Results: The study included a total of 417 women. Median follow-up was 48 (range 7-114) months. Nodal status after neoadjuvant systemic therapy, but not before, was significantly associated with crude survival: residual nodal disease (ypN+) resulted in a significantly shorter 5-year OS compared with a complete nodal response (ypN0) (83⋅3 versus 91⋅0 per cent; P = 0⋅017). The agreement between breast (ypT) and nodal (ypN) status after neoadjuvant systemic therapy was high, and more so in patients with cN0 tumours (64 of 66, 97 per cent) than those with cN+ disease (49 of 60, 82 per cent) (P = 0⋅005). In multivariable analysis, ypN0 (hazard ratio 0⋅41, 95 per cent c.i. 0⋅22 to 0⋅74; P = 0⋅003) and local radiotherapy (hazard ratio 0⋅23, 0⋅08 to 0⋅64; P = 0⋅005) were associated with improved IDFS, and triple-negative molecular subtype with worse IDFS. Conclusion: The present findings underline the prognostic significance of nodal status after neoadjuvant systemic therapy. This confirms the clinical value of surgical axillary staging after neoadjuvant systemic therapy.

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Section: Discussionmentioning

confidence: 99%

Long-term prognosis in breast cancer is associated with residual disease after neoadjuvant systemic therapy but not with initial nodal status

Zetterlund

Celebioglu

Hatschek

et al. 2021

British Journal of Surgery

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“…Several groups have found that adding MRI response of the primary tumor to clinicopathologic data achieves significantly better predictive power. [74][75][76][77] Ha et al trained an artificial intelligence algorithm to predict pCR in the axilla based on pretreatment MRI of the in-breast tumor alone, achieving an overall accuracy of 83%. 78 These models could improve prediction of axillary disease and allow better preoperative planning and patient counseling regarding surgical and radiation options.…”

Section: Lymph Node Evaluationmentioning

confidence: 99%

“…Negative hormone receptor and positive HER2 receptor status, lower clinical T and N stages, high histologic/nuclear grade, and breast tumor response to neoadjuvant therapy are predictors for axillary pCR. Several groups have found that adding MRI response of the primary tumor to clinicopathologic data achieves significantly better predictive power 74–77 . Ha et al trained an artificial intelligence algorithm to predict pCR in the axilla based on pretreatment MRI of the in‐breast tumor alone, achieving an overall accuracy of 83% 78 .…”

Section: Lymph Node Evaluationmentioning

confidence: 99%

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

Reig

Heacock

Lewin

et al. 2020

Magnetic Resonance Imaging

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The goals of imaging after neoadjuvant therapy for breast cancer are to monitor the response to therapy and facilitate surgical planning. MRI has been found to be more accurate than mammography, ultrasound, or clinical exam in evaluating treatment response. However, MRI may both overestimate and underestimate residual disease. The accuracy of MRI is dependent on tumor morphology, histology, shrinkage pattern, and molecular subtype. Emerging MRI techniques that combine functional information such as diffusion, metabolism, and hypoxia may improve MR accuracy. In addition, machine-learning techniques including radiomics and radiogenomics are being studied with the goal of predicting View this article online at wileyonlinelibrary.com.

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“…The improvement in survival is more likely to occur in triple negative breast cancer, and in human epidermal growth factor 2 (HER2)-positive breast cancer, particularly when trastuzumab is added to the treatment regimen. The patients who achieve axillary pCR, show better loco-regional and survival outcomes, irrespective of the primary tumor response [45710111213141516]. NAT also provides adequate time for genetic testing, and planning for breast reconstruction, when indicated.…”

mentioning

confidence: 99%

“…The rates for axillary pCR are higher, reaching up to 37% (between 5% and 75%). This rate reaches up to 21% in patients with estrogen receptor-positive/HER2-negative tumors, 60% in triple negative tumors, between 67% and 73% in HER2-positive tumors when trastuzumab is used in combination with chemotherapy, and up to 97% when dual HER2 blockage is applied [7810111516202324].…”

mentioning

confidence: 99%

Neoadjuvant Therapy Should Be the Standard of Care for Every Node Positive Breast Cancer Patient

Hamdy

2019

J Breast Cancer

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Risk scoring system for predicting axillary response after neoadjuvant chemotherapy in initially node-positive women with breast cancer

Cited by 16 publications

References 31 publications

Long-term prognosis in breast cancer is associated with residual disease after neoadjuvant systemic therapy but not with initial nodal status

Long-term prognosis in breast cancer is associated with residual disease after neoadjuvant systemic therapy but not with initial nodal status

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

Neoadjuvant Therapy Should Be the Standard of Care for Every Node Positive Breast Cancer Patient

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