Retrospective comprehensive analysis of regional lymph node recurrence in breast cancer patients (REASON study).

IF 2.7 3区 医学 Q3 ONCOLOGY
Aikaterini Liapi, Veronica Aedo-Lopez, Wendy Jeanneret-Sozzi, Athina Stravodimou, John O Prior, Marie Nicod Lalonde, Assia Ifticene Treboux, Loic Lelievre, Lana Kandalaft, Laetitia Rossier, Audrey Goupil, Marzio Bergomi, Jean-Paul Rivals, Jean-Philippe Brouland, Elsa Curtit, Jean-Yves Meuwly, Khalil Zaman
{"title":"Retrospective comprehensive analysis of regional lymph node recurrence in breast cancer patients (REASON study).","authors":"Aikaterini Liapi, Veronica Aedo-Lopez, Wendy Jeanneret-Sozzi, Athina Stravodimou, John O Prior, Marie Nicod Lalonde, Assia Ifticene Treboux, Loic Lelievre, Lana Kandalaft, Laetitia Rossier, Audrey Goupil, Marzio Bergomi, Jean-Paul Rivals, Jean-Philippe Brouland, Elsa Curtit, Jean-Yves Meuwly, Khalil Zaman","doi":"10.1007/s00432-025-06235-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Randomized trials have progressively enabled the de-escalation of axillary surgery in breast cancer (BC) patients, reducing adverse events without compromising survival. Despite a not negligible rate of residual disease in the axilla after sentinel lymph node (SLN) procedure, the risk of regional lymph node recurrence (RLNR) is very low, due probably to multimodal adjuvant treatments. The characteristics of the small number of patients with RLNR remain poorly characterized and warrant further investigation, especially given their poor prognosis and the current context of ongoing studies exploring further de-escalation of axillary surgery.</p><p><strong>Methods: </strong>In this retrospective and single institution study, we analyzed thoroughly a cohort of patients who experienced RLNR as first event between 2009 and 2020. MammaPrint and BluePrint analysis (MB) was performed in available primary invasive cancer tissues.</p><p><strong>Results: </strong>Forty patients, median age of 52, were analyzed. Disease-free interval was 8.7 years. Most of the patients (65%) had no special type BC. Majority (73%) had hormone receptor positive-HER2 negative (HR + /HER2-) BC, 13% triple negative (TNBC), 6% HER2 + , 8% ductal carcinoma in situ and 3% unknown. The median size of the primary tumor was 1.8 cm (range 0.3-7.0) and 57% had no initial LN involvement. Forty five percent had primary SLN procedure and 53% axillary LN dissection (ALND) of the patients received neo-/adjuvant chemotherapy, 63% endocrine therapy and 68% radiotherapy (50% only in breast). Sixty three percent had only RLNR and 38% had concomitant distant metastases. Among irradiated patients, 63% had some relapse in the radiation field. The MB analysis classified 70% of the analyzed cancers as low-risk luminal A (82% in HR + /HER2-), 15% high-risk luminal B, 10% high-risk basal type, and 5% high-risk HER2 type.</p><p><strong>Conclusion: </strong>Our study confirms that patients treated with SLN do not show a higher risk of LRNR compared to ALND. LRNR is often diagnosed incidentally. Younger age, residual disease post-NAC, no regional radiation, stage II, and initial LN involvement were more represented, as well as patients with endocrine sensitive disease classified as low-risk luminal A by MB. Ongoing trials, including SOUND, INSEMA, and BOOG 2013-08, are further exploring axillary surgery de-escalation.</p>","PeriodicalId":15118,"journal":{"name":"Journal of Cancer Research and Clinical Oncology","volume":"151 5","pages":"176"},"PeriodicalIF":2.7000,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122638/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cancer Research and Clinical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00432-025-06235-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Randomized trials have progressively enabled the de-escalation of axillary surgery in breast cancer (BC) patients, reducing adverse events without compromising survival. Despite a not negligible rate of residual disease in the axilla after sentinel lymph node (SLN) procedure, the risk of regional lymph node recurrence (RLNR) is very low, due probably to multimodal adjuvant treatments. The characteristics of the small number of patients with RLNR remain poorly characterized and warrant further investigation, especially given their poor prognosis and the current context of ongoing studies exploring further de-escalation of axillary surgery.

Methods: In this retrospective and single institution study, we analyzed thoroughly a cohort of patients who experienced RLNR as first event between 2009 and 2020. MammaPrint and BluePrint analysis (MB) was performed in available primary invasive cancer tissues.

Results: Forty patients, median age of 52, were analyzed. Disease-free interval was 8.7 years. Most of the patients (65%) had no special type BC. Majority (73%) had hormone receptor positive-HER2 negative (HR + /HER2-) BC, 13% triple negative (TNBC), 6% HER2 + , 8% ductal carcinoma in situ and 3% unknown. The median size of the primary tumor was 1.8 cm (range 0.3-7.0) and 57% had no initial LN involvement. Forty five percent had primary SLN procedure and 53% axillary LN dissection (ALND) of the patients received neo-/adjuvant chemotherapy, 63% endocrine therapy and 68% radiotherapy (50% only in breast). Sixty three percent had only RLNR and 38% had concomitant distant metastases. Among irradiated patients, 63% had some relapse in the radiation field. The MB analysis classified 70% of the analyzed cancers as low-risk luminal A (82% in HR + /HER2-), 15% high-risk luminal B, 10% high-risk basal type, and 5% high-risk HER2 type.

Conclusion: Our study confirms that patients treated with SLN do not show a higher risk of LRNR compared to ALND. LRNR is often diagnosed incidentally. Younger age, residual disease post-NAC, no regional radiation, stage II, and initial LN involvement were more represented, as well as patients with endocrine sensitive disease classified as low-risk luminal A by MB. Ongoing trials, including SOUND, INSEMA, and BOOG 2013-08, are further exploring axillary surgery de-escalation.

乳腺癌患者区域淋巴结复发的回顾性综合分析(REASON研究)。
背景:随机试验逐渐使乳腺癌(BC)患者腋窝手术的风险降低,在不影响生存的情况下减少不良事件。尽管前哨淋巴结(SLN)手术后腋窝残留疾病的发生率不可忽视,但区域淋巴结复发(RLNR)的风险非常低,这可能是由于多模式辅助治疗。少数RLNR患者的特征仍然不明确,值得进一步研究,特别是考虑到他们的预后不良,以及目前正在进行的研究探索进一步降低腋窝手术的风险。方法:在这项回顾性的单机构研究中,我们对2009年至2020年间首次发生RLNR的患者进行了全面分析。对可用的原发性浸润性癌组织进行mamaprint和BluePrint分析(MB)。结果:本组患者40例,中位年龄52岁。无病间隔为8.7年。大多数患者(65%)没有特殊类型的BC。大多数(73%)患有激素受体阳性HER2阴性(HR + /HER2-) BC, 13%三阴性(TNBC), 6% HER2 +, 8%导管原位癌和3%未知。原发肿瘤的中位大小为1.8 cm(范围0.3-7.0),57%的患者最初没有淋巴结累及。45%的患者进行了原发性淋巴结转移手术,53%的患者接受了新/辅助化疗,63%的患者接受了内分泌治疗,68%的患者接受了放疗(50%仅在乳房)。63%的患者只有RLNR, 38%的患者伴有远处转移。在接受放射治疗的患者中,63%的患者在放射领域有一定程度的复发。MB分析将70%的分析癌症分类为低危luminal A(82%为HR + /HER2-), 15%为高危luminal B, 10%为高危基础型,5%为高危HER2型。结论:我们的研究证实,与ALND相比,接受SLN治疗的患者没有更高的LRNR风险。LRNR通常是偶然发现的。年龄较小、nac后残留疾病、无区域放疗、II期和初始LN累及以及内分泌敏感疾病患者被MB分类为低风险腔腔A。正在进行的试验,包括SOUND、INSEMA和BOOG 2013-08,正在进一步探索腋窝手术的降级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.00
自引率
2.80%
发文量
577
审稿时长
2 months
期刊介绍: The "Journal of Cancer Research and Clinical Oncology" publishes significant and up-to-date articles within the fields of experimental and clinical oncology. The journal, which is chiefly devoted to Original papers, also includes Reviews as well as Editorials and Guest editorials on current, controversial topics. The section Letters to the editors provides a forum for a rapid exchange of comments and information concerning previously published papers and topics of current interest. Meeting reports provide current information on the latest results presented at important congresses. The following fields are covered: carcinogenesis - etiology, mechanisms; molecular biology; recent developments in tumor therapy; general diagnosis; laboratory diagnosis; diagnostic and experimental pathology; oncologic surgery; and epidemiology.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信