Clémentine Jankowski, Gilles Houvenaeghel, Celine Renaudeau, Jean Leveque, Frederic Marchal, Amélie Benbara, Emmanuel Barranger, Roman Rouzier, Monique Cohen, Jean-Marc Classe, Sylvain Ladoire, Charles Coutant
{"title":"How can we optimize the surgical management of the axilla in breast cancer since the MonarchE trial?","authors":"Clémentine Jankowski, Gilles Houvenaeghel, Celine Renaudeau, Jean Leveque, Frederic Marchal, Amélie Benbara, Emmanuel Barranger, Roman Rouzier, Monique Cohen, Jean-Marc Classe, Sylvain Ladoire, Charles Coutant","doi":"10.1007/s10549-025-07642-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Results of MonarchE trial have changed adjuvant therapy for estrogen-receptor-positive (ER+), HER-2-negative breast cancer. Given the importance of the extent of nodal disease in this study, surgical management of the axilla has resurfaced as a question asked at multidisciplinary boards.</p><p><strong>Methods: </strong>Using data from a cohort of Werkoff (JCO, 2009) in which patients underwent both sentinel lymph node(SLN) biopsy and axillary node dissection (ALND), we assessed the proportion of patients in whom the absence of ALND would have led to a lack of awareness of \"high-risk\" status. We evaluated the contribution of the Katz nomogram (that predict pN2/N3 stage) to guide possible indications for complementary ALND.</p><p><strong>Results: </strong>Among the 536 patients, 88 were excluded (ER- and/or isolated cells in SLN). Of patients with 1 or 2 SLN + (n = 352), only 7.9% were pN2/N3. When the ratio (number of SLN + /total number of SLN sampled) was less than 1, only 3.9% were pN2/N3. Patients with 1 or 2 SLN + met the ACOSOG Z0011 criteria so none would benefit from an ALND, but 7.9% of patients at high risk will not receive Abemaciclib. If we use the Katz nomogram (threshold ≤ 5%), this rate decrease at 3.3% but 116 patients will have an ALND with no benefit. With a threshold ≤ 20%, 5% patients at high risk will not receive Abemaciclib but 21 patients will have an ALND with no benefit.</p><p><strong>Conclusion: </strong>The indications for adjuvant Abemaciclib should not lead to surgical escalation in the management of the axilla.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"13-21"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer Research and Treatment","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10549-025-07642-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/6 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Results of MonarchE trial have changed adjuvant therapy for estrogen-receptor-positive (ER+), HER-2-negative breast cancer. Given the importance of the extent of nodal disease in this study, surgical management of the axilla has resurfaced as a question asked at multidisciplinary boards.
Methods: Using data from a cohort of Werkoff (JCO, 2009) in which patients underwent both sentinel lymph node(SLN) biopsy and axillary node dissection (ALND), we assessed the proportion of patients in whom the absence of ALND would have led to a lack of awareness of "high-risk" status. We evaluated the contribution of the Katz nomogram (that predict pN2/N3 stage) to guide possible indications for complementary ALND.
Results: Among the 536 patients, 88 were excluded (ER- and/or isolated cells in SLN). Of patients with 1 or 2 SLN + (n = 352), only 7.9% were pN2/N3. When the ratio (number of SLN + /total number of SLN sampled) was less than 1, only 3.9% were pN2/N3. Patients with 1 or 2 SLN + met the ACOSOG Z0011 criteria so none would benefit from an ALND, but 7.9% of patients at high risk will not receive Abemaciclib. If we use the Katz nomogram (threshold ≤ 5%), this rate decrease at 3.3% but 116 patients will have an ALND with no benefit. With a threshold ≤ 20%, 5% patients at high risk will not receive Abemaciclib but 21 patients will have an ALND with no benefit.
Conclusion: The indications for adjuvant Abemaciclib should not lead to surgical escalation in the management of the axilla.
期刊介绍:
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.