Nodal involvement in patients with small, clinically node-negative HER2-positive breast cancer after staging with FDG-PET/CT and neoadjuvant systemic therapy

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2024-10-18 DOI:10.1016/j.breast.2024.103822

Josefien P. van Olmen , Veerle CM. Geurts , Marie-Jeanne TFD. Vrancken Peeters , Caroline A. Drukker , Marcel PM. Stokkel , Marleen Kok , Frederieke H. van Duijnhoven

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引用次数: 0

Abstract

Background

Guidelines recommend systemic therapy for stage I HER2+ breast cancer (BC). Neoadjuvant systemic treatment (NAST) allows response-guided adjuvant treatment. However, prior to NAST only clinical nodal staging is available, risking undertreatment if ypN+ is observed. Here, we aim to evaluate the impact of FDG-PET/CT and NAST on nodal disease status in patients with small, node-negative HER2+ BC.

Methods

This retrospective study included patients with small (≤3 cm), clinically node-negative HER2+ BC diagnosed between 2011 and 2023. Primary outcome was the proportion of patients with nodal disease on final pathology after upfront surgery or NAST followed by surgery with or without FDG-PET/CT. Patients received either paclitaxel + trastuzumab (PT) or a more extensive regimen.

Results

Of the 370 included patients, 183 underwent FDG-PET/CT, detecting regional or distant metastases in 14 patients (7.7 %).

Among 356 patients with cN0 disease, 44.1 % (n = 157/356) had upfront surgery, with only 3 % (5/157) having an FDG-PET/CT. The remaining 55.9 % (199/356) started with NAST, with 82 % (n = 164/199) having an FDG-PET/CT. Among patients treated with NAST, 36 % received PT.

Nodal involvement on pathology was seen in 19.1 % (n = 29/152) after upfront surgery without FDG-PET/CT and 6.1 % (10/164) after NAST combined with FDG-PET/CT.

After NAST, 58 % had a pCR (PT: 49 %, other: 63 %). Nodal involvement on final pathology was seen in 6.9 % after PT and in 5.5 % after more extensive regimen.

Conclusions

The proportion of patients with ypN + after NAST combined with FDG-PET/CT was only 6.1 %. Neoadjuvant treatment can be a safe treatment strategy for patients with stage I HER2+ BC.

查看原文本刊更多论文

临床结节阴性 HER2 阳性小乳腺癌患者在使用 FDG-PET/CT 和新辅助系统疗法分期后的结节受累情况。

背景：指南建议对I期HER2+乳腺癌（BC）进行全身治疗。新辅助系统性治疗（NAST）允许在反应指导下进行辅助治疗。然而，在进行新辅助全身治疗之前，只能进行临床结节分期，如果观察到ypN+，就有可能导致治疗不足。在此，我们旨在评估FDG-PET/CT和NAST对HER2+ BC小结节阴性患者结节疾病状态的影响：这项回顾性研究纳入了2011年至2023年期间确诊的小结节（≤3厘米）、临床结节阴性HER2+ BC患者。主要研究结果是患者在接受前期手术或NAST后接受手术并进行或不进行FDG-PET/CT检查后，最终病理结果出现结节性疾病的比例。患者接受紫杉醇+曲妥珠单抗（PT）或更广泛的治疗方案：在纳入的370名患者中，183人接受了FDG-PET/CT检查，其中14人（7.7%）发现了区域或远处转移。在356名cN0患者中，44.1%（n = 157/356）接受了前期手术，只有3%（5/157）接受了FDG-PET/CT检查。其余55.9%的患者（199/356）开始接受NAST治疗，其中82%（n = 164/199）接受了FDG-PET/CT检查。在接受 NAST 治疗的患者中，36% 接受了 PT 治疗。在未进行 FDG-PET/CT 的前期手术后，19.1% 的患者（n = 29/152）在病理检查中发现结节受累，而在接受 NAST 联合 FDG-PET/CT 治疗后，6.1% 的患者（10/164）在病理检查中发现结节受累。NAST术后，58%的患者获得了pCR（PT：49%，其他：63%）。经过PT治疗后，最终病理结果显示结节受累的比例为6.9%，经过更广泛治疗后，结节受累的比例为5.5%：结论：NAST联合FDG-PET/CT治疗后，ypN+患者的比例仅为6.1%。对于HER2+ BC I期患者来说，新辅助治疗是一种安全的治疗策略。

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

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.