How can we optimize the surgical management of the axilla in breast cancer since the MonarchE trial?

IF 3 3区医学 Q2 ONCOLOGY

Breast Cancer Research and Treatment Pub Date : 2025-07-01 Epub Date: 2025-05-06 DOI:10.1007/s10549-025-07642-5

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

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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.

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自MonarchE试验以来，我们如何优化乳腺癌腋窝的手术治疗？

目的：MonarchE试验的结果改变了雌激素受体阳性（ER+）、her -2阴性乳腺癌的辅助治疗方法。鉴于本研究中淋巴结疾病程度的重要性，腋窝的手术治疗已重新成为多学科委员会提出的一个问题。方法：使用来自Werkoff （JCO, 2009）队列的数据，其中患者同时接受前哨淋巴结（SLN）活检和腋窝淋巴结清扫（ALND），我们评估了由于缺乏ALND而导致对“高风险”状态缺乏认识的患者比例。我们评估了Katz nomogram（预测pN2/N3分期）对指导补偿性ALND的可能适应症的贡献。结果：在536例患者中，88例被排除（SLN中的ER和/或分离细胞）。在1或2 SLN + (n = 352)患者中，只有7.9%为pN2/N3。当采样的SLN数+ /总SLN数之比小于1时，pN2/N3仅占3.9%。1或2个SLN +的患者符合ACOSOG Z0011标准，因此没有人会从ALND中受益，但7.9%的高风险患者不会接受Abemaciclib。如果我们使用Katz nomogram（阈值≤5%），这一比率下降到3.3%，但116名患者将患有ALND而没有获益。当阈值≤20%时，5%的高风险患者不会接受Abemaciclib治疗，但21例患者将出现无获益的ALND。结论：阿贝马昔利布辅助治疗的适应症不应导致腋窝治疗的手术升级。

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 Cancer Research and Treatment 医学-肿瘤学

CiteScore

6.80

自引率

2.60%

发文量

342

审稿时长

1 months

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.