Does neoadjuvant chemotherapy provide any benefit for surgical de-escalation in luminal B, HER2(-) breast cancers?

IF 0.5 4区医学 Q4 SURGERY

Cirugia Y Cirujanos Pub Date : 2023-01-01 DOI:10.24875/CIRU.22000277

Aysegul Aktas, Meryem Gunay-Gurleyik, Fugen Aker, Yasar Kaan-Akgok, Elif Atag

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引用次数: 0

Abstract

Background: The use of neoadjuvant chemotherapy (NAC) in less aggressive breast cancer (BC) is controversial.

Objective: To investigate the effect of neoadjuvant chemotherapy in HER2 negative luminal B breast cancer.

Patients and methods: Patients between January 2016 and December 2021 were retrospectively evaluated.

Results: A total of 128 patients were included in the study. Patients with pathological complete response (pCR) were younger and had higher ki67 levels. Cutoff levels for ki67 based on pCR and ypT status were ≤ 40% and ≤ 35%, respectively. According to pre-NAC magnetic resonance imaging findings, only mastectomy was viable in 90 patients, but after NAC breast-conserving surgery (BCS) was possible in 29 (32%). Moreover, 68.5% became eligible for sentinel lymph node biopsy (SLNB) after NAC. Since SLNB was positive in 45 (54.2%), axillary lymph node dissection (ALND) was performed and the remainder, 38 (31.4%), avoided ALND.

Conclusion: In patients with Luminal B, HER2(-) BC a low pCR rate should not discourage the use of NAC. The ki67 level is a guide for individualizing treatment. Especially in young patients with high ki67 levels, NAC increases the chance of breast-conserving surgery and may spare patients from ALND.

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新辅助化疗对腔内B型、HER2(-)型乳腺癌的手术缓解有任何益处吗?

背景:在低侵袭性乳腺癌(BC)中使用新辅助化疗(NAC)是有争议的。目的:探讨新辅助化疗对HER2阴性B腔乳腺癌的治疗效果。患者和方法:回顾性评估2016年1月至2021年12月的患者。结果:共纳入128例患者。病理完全缓解(pCR)的患者年龄较小，ki67水平较高。基于pCR和ypT状态的ki67的截止水平分别为≤40%和≤35%。根据NAC前的磁共振成像结果，只有90例患者可以进行乳房切除术，但NAC后可以进行保乳手术(BCS) 29例(32%)。此外，68.5%的患者在NAC后符合前哨淋巴结活检(SLNB)的条件。由于SLNB阳性45例(54.2%)，行腋窝淋巴结清扫术(ALND)，其余38例(31.4%)避免行ALND。结论:在Luminal B、HER2(-) BC患者中，低pCR率不应阻碍NAC的使用。ki67水平是个体化治疗的指导。特别是在ki67水平高的年轻患者中，NAC增加了保乳手术的机会，并可能使患者免于ALND。

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

Cirugia Y Cirujanos 医学-外科

CiteScore

0.90

自引率

20.00%

发文量

207

审稿时长

6-12 weeks

期刊介绍： Cirugía y Cirujanoses exponente del desarrollo académico, científico, médico, quirúrgico y tecnológico en materia de salud en México y en el ámbito internacional. Es una revista bimestral, open access, revisada por pares, que publica en español y en inglés (traducido sin coste para los autores) artículos científicos originales, casos clínicos, artículos de revisión de interés general y cartas al editor. Los artículos se seleccionan y publican siguiendo un riguroso análisis, de acuerdo con los estándares internacionalmente aceptados. Sus espacios están abiertos a los académicos, así como a todo miembro de la comunidad médica que manifieste interés por utilizar este foro para publicar sus trabajos.