Axillary management and long-term oncologic outcomes in breast cancer patients with clinical N1 disease treated with neoadjuvant chemotherapy.

IF 2.5 3区医学 Q3 ONCOLOGY

World Journal of Surgical Oncology Pub Date : 2024-07-29 DOI:10.1186/s12957-024-03477-4

Courtney C Sparger, Alexandra E Hernandez, Kristin E Rojas, Khadeja Khan, Gili G Halfteck, Mecker Möller, Eli Avisar, Neha Goel, Jessica S Crystal, Susan B Kesmodel

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引用次数: 0

Abstract

Background: Low false negative rates can be achieved with sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with clinical N1 (cN1) disease. We examined changes in axillary management and oncologic outcomes in BC patients with cN1 disease receiving NAC.

Methods: BC patients with biopsy proven cN1 disease treated with NAC were selected from our institutional cancer registry (2014-2017). Patients were grouped by axillary management, axillary lymph node dissection (ALND), SLNB followed by ALND, or SLNB alone. Univariable and multivariable survival analysis for recurrence-free survival (RFS) and overall survival (OS) were performed.

Results: 81 patients met inclusion criteria: 31 (38%) underwent ALND, 25 (31%) SLNB + ALND, and 25 (31%) SLNB alone. A SLN was identified in 45/50 (90%) patients who had SLNB. ALND was performed in 25/50 (50%) patients who had SLNB: 18 for a + SLNB, 5 failed SLNB, and 2 insufficient SLNs. 25 patients had SLNB alone, 17 were SLN- and 8 SLN+. In the SLNB alone group, 23/25 (92%) patients received adjuvant radiation (RT). 20 (25%) patients developed BC recurrence: 14 distant (70%), 3 local (15%), 2 regional + distant (10%), and 1 contralateral (5%). In the SLNB alone group, there was 1 axillary recurrence in a patient with a negative SLNB who did not receive RT. Univariable survival analysis showed significant differences in RFS and OS between axillary management groups, ALND/SLNB + ALND vs. SLNB alone (RFS: p = 0.006, OS: p = 0.021). On multivariable survival analysis, worse RFS and OS were observed in patients with TNBC (RFS: HR 3.77, 95% CI 1.70-11.90, p = 0.023; OS: HR 8.10, 95% CI 1.84-35.60, p = 0.006).

Conclusions: SLNB alone and RT after NAC in BC patients with cN1 disease who have negative SLNs at surgery provides long-term regional disease control. This analysis provides support for the practice of axillary downstaging with NAC and SLNB alone.

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接受新辅助化疗的临床 N1 级乳腺癌患者的腋窝管理和长期肿瘤治疗效果。

背景：临床N1（cN1）病变的乳腺癌（BC）患者在接受新辅助化疗（NAC）后进行前哨淋巴结活检（SLNB）可获得较低的假阴性率。我们研究了接受新辅助化疗的 cN1 乳腺癌患者腋窝管理和肿瘤治疗效果的变化：我们从本机构的癌症登记处（2014-2017 年）中选取了经活检证实患有 cN1 疾病并接受 NAC 治疗的 BC 患者。患者按腋窝处理、腋窝淋巴结清扫（ALND）、SLNB后进行ALND或仅进行SLNB进行分组。对无复发生存期（RFS）和总生存期（OS）进行单变量和多变量生存分析：81名患者符合纳入标准：31人（38%）接受了ALND，25人（31%）接受了SLNB+ALND，25人（31%）仅接受了SLNB。45/50（90%）名接受 SLNB 的患者确定了 SLN。25/50（50%）名进行了 SLNB 的患者进行了 ALND：18 名为 + SLNB，5 名 SLNB 失败，2 名 SLN 不全。25 名患者仅进行了 SLNB，其中 17 名为 SLN-，8 名为 SLN+。在单纯 SLNB 组中，23/25（92%）名患者接受了辅助放射治疗（RT）：14例远处复发（70%），3例局部复发（15%），2例区域+远处复发（10%），1例对侧复发（5%）。在单纯 SLNB 组中，有 1 例腋窝复发，患者的 SLNB 为阴性，但未接受 RT 治疗。单变量生存分析显示，ALND/SLNB + ALND 组与单纯 SLNB 组的 RFS 和 OS 存在显著差异（RFS：P = 0.006，OS：P = 0.021）。多变量生存分析显示，TNBC 患者的 RFS 和 OS 较差（RFS：HR 3.77，95% CI 1.70-11.90，p = 0.023；OS：HR 8.10，95% CI 1.70-11.90，p = 0.023）：HR：8.10，95% CI 1.84-35.60，p = 0.006）：结论：对于手术时SLN阴性的cN1疾病BC患者，单纯SLNB和NAC后RT可长期控制区域疾病。这项分析为使用 NAC 和 SLNB 进行腋窝下分期的做法提供了支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.