Cancer最新文献

{"title":"Reply to \"Assessing mental health impact on chemotherapy toxicity in older adults\".","authors":"Reena V Jayani, Canlan Sun, William Dale","doi":"10.1002/cncr.35644","DOIUrl":"https://doi.org/10.1002/cncr.35644","url":null,"abstract":"","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive approach to defining the cutoff value of oligometastasis in head and neck squamous cell carcinoma.","authors":"Diako Berzenji, Olivier R G Oude Booijink, Renske Gahrmann, Hetty Mast, Marta E Capala, Sjors A Koppes, Esther van Meerten, Bernd Kremer, Robert Jan Baatenburg de Jong, Marinella P J Offerman, Jose A Hardillo","doi":"10.1002/cncr.35632","DOIUrl":"https://doi.org/10.1002/cncr.35632","url":null,"abstract":"<p><strong>Background: </strong>Patients with limited distant metastatic disease, also known as oligometastasis, show better survival rates than polymetastatic patients, and may be amenable for curative-intent treatment. The definition of oligometastasis, however, is unknown, and no quantitative analyses on the cutoff value for oligometastasis have been performed before. This study aims to derive specific threshold values for the number of metastases and affected locations that defines oligometastatic disease in head and neck squamous cell carcinoma.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including all patients diagnosed with distant metastases between 2006 and 2021. For each patient, the number of distant metastases and affected locations was recorded on the basis of the available imaging at the time of diagnosis. Cox regression analyses and a machine-learning k-means algorithm were used to determine threshold values.</p><p><strong>Results: </strong>A total of 384 patients untreated for their metastatic foci were analyzed. Most patients (n = 207; 53.9%) had metastasis to one anatomic location, followed by metastases in two anatomic locations (n = 62; 16.1%). The majority of patients had ≥9 metastatic foci (n = 174; 45.3%), followed by one focus (n = 74; 19.3%) and two foci (n = 32; 8.3%). Cox regression and machine-learning k-means models showed that although the number of metastases did not predict survival, the number of affected locations did significantly (p < .001), by identifying a threshold of two locations.</p><p><strong>Conclusions: </strong>Contrary to the prevalent dogma, the definition of oligometastasis should not be defined by the number of metastases but rather by the number of affected locations, with a maximum number of affected locations set at two.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.","authors":"Arnav Srivastava, Xiu Liu, Avinash Maganty, Samuel R Kaufman, Addison Shay, Mary Oerline, Christopher Dall, Kassem S Faraj, Andrew M Ryan, Brent K Hollenbeck, Vahakn B Shahinian","doi":"10.1002/cncr.35633","DOIUrl":"https://doi.org/10.1002/cncr.35633","url":null,"abstract":"<p><strong>Background: </strong>For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may \"spillover\" to the Medicare population and affect quality. This study evaluated the effects of practice-level commercial prices on health care utilization and quality in men with prostate cancer insured by traditional Medicare.</p><p><strong>Methods: </strong>From a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer between 2014-2019 (n = 44,653). Using commercial payments from the MarketScan database, they developed a practice-level commercial price index (ratio of commercial prices to Medicare prices). They examined the association of the price index with price standardized spending, overtreatment (treatment among those with >50% noncancer mortality within 10 years), and underuse of diagnostic testing in active surveillance (at least one prostate-specific antigen test and one confirmatory test-MRI, prostate biopsy, genomic test-within 12 months of diagnosis).</p><p><strong>Results: </strong>Practice-level commercial price indices varied from 1.34 (134% of Medicare prices), for practices in the bottom decile, to 3.00, for practices in the top decile. Increasing price index was associated with lower odds of overtreatment (odds ratio, 0.86; 95% confidence interval, 0.76-0.97; p = .01), but not price standardized spending or underuse of diagnostic testing in active surveillance.</p><p><strong>Conclusions: </strong>Commercial prices vary markedly across urology practices. Among newly diagnosed men with traditional Medicare, those managed by practices with higher commercial price indices had lower odds of overtreatment, suggesting improved prostate cancer care quality.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing de novo chronic myeloid leukemia in blastic phase with Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation.","authors":"Yosuke Okada, Noriaki Tachi, Yutaka Shimazu, Makoto Murata, Satoshi Nishiwaki, Yasushi Onishi, Atsushi Jinguji, Naoyuki Uchida, Masatsugu Tanaka, Yuta Hasegawa, Ayumu Ito, Shinichi Kako, Tetsuya Nishida, Koichi Onodera, Masashi Sawa, Hirohisa Nakamae, Masako Toyosaki, Yoshinobu Kanda, Makoto Onizuka, Takahiro Fukuda, Marie Ohbiki, Yoshiko Atsuta, Yasuyuki Arai, Takayoshi Tachibana","doi":"10.1002/cncr.35627","DOIUrl":"https://doi.org/10.1002/cncr.35627","url":null,"abstract":"<p><strong>Background: </strong>De novo chronic myeloid leukemia in blastic phase (CML-BP) showing lymphoid immunophenotype mimics Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). Although upfront allogeneic hematopoietic cell transplantation (HCT) is considered in both diseases, it is not yet clear whether the transplant outcomes are also similar.</p><p><strong>Methods: </strong>Using a registry database, the transplant outcomes between de novo CML-BP and Ph-positive ALL in negative-minimal residual disease (MRD), positive MRD, and nonremission cohorts were compared, respectively. All of the included patients had received tyrosine kinase inhibitor therapy before HCT and underwent HCT between 2002 and 2021. Regarding Ph-positive ALL, patients with p210 transcripts were excluded because there was concern that this group might include patients with de novo CML-BP.</p><p><strong>Results: </strong>Although most of the outcomes were comparable, in patients with positive MRD at HCT, de novo CML-BP was significantly associated with superior disease-free survival (DFS) (hazard ratio [HR] 0.6, p = .0032), overall survival (HR 0.66, p = .027), and a lower risk of relapse (HR 0.48, p = .0051). In subgroup analyses, BCR::ABL1 mutation status had a significant interaction with the disease (p for interaction = .0027). De novo CML-BP seemed to be associated with superior disease-free survival in a BCR::ABL1 mutation-positive cohort, whereas this association was not observed in a mutation-negative cohort.</p><p><strong>Conclusions: </strong>Considering previous reports that showed inferior outcomes for de novo CML-BP compared to Ph-positive ALL, the data suggested that allogeneic HCT could overcome the poor prognosis of de novo CML-BP. These findings highlight the importance of distinguishing de novo CML-BP from Ph-positive ALL.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pesticides and prostate cancer incidence and mortality: An environment-wide association study.","authors":"Simon John Christoph Soerensen, David S Lim, Maria E Montez-Rath, Glenn M Chertow, Benjamin I Chung, David H Rehkopf, John T Leppert","doi":"10.1002/cncr.35572","DOIUrl":"https://doi.org/10.1002/cncr.35572","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer is the most common cancer among men in the United States, yet modifiable risk factors remain elusive. In this study, the authors investigated the potential role of agricultural pesticide exposure in prostate cancer incidence and mortality.</p><p><strong>Methods: </strong>For this environment-wide association study (EWAS), linear regression was used to analyze county-level associations between the annual use of 295 distinct pesticides (measured in kg per county) and prostate cancer incidence and mortality rates in the contiguous United States. Data were analyzed in two cohorts: 1997-2001 pesticide use with 2011-2015 outcomes (discovery) and 2002-2006 use with 2016-2020 outcomes (replication). The reported effect sizes highlight how a 1-standard-deviation increase in log-transformed pesticide use (kg per county) corresponds to changes in incidence. Analyses were adjusted for county-level demographics, agricultural data, and multiple testing.</p><p><strong>Results: </strong>Twenty-two pesticides showed consistent, direct associations with prostate cancer incidence across both cohorts. Of these, four pesticides were also associated with prostate cancer mortality. In the replication cohort, each 1-standard-deviation increase in log-transformed pesticide use corresponded to incidence increases per 100,000 individuals (trifluralin, 6.56 [95% confidence interval (CI), 5.04-8.07]; cloransulam-methyl, 6.18 [95% CI, 4.06-8.31]; diflufenzopyr, 3.20 [95% CI, 1.09-5.31]; and thiamethoxam, 2.82 [95% CI, 1.14-4.50]). Limitations included ecological study design, potential unmeasured confounding, and lack of individual-level exposure data.</p><p><strong>Conclusions: </strong>The results of this study suggest a potential link between certain pesticides and increased prostate cancer incidence and mortality. These findings warrant further investigation of these specific pesticides to confirm their role in prostate cancer risk and to develop potential public health interventions.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials.","authors":"Logan G Briggs, Sara C Parke, Kelsey L Beck, Debarshi Sinha, Vikram Gill, Matthew J Van Ligten, Paul A Bain, Mark D Tyson, Haidar M Abdul-Muhsin, Jaxon K Quillen, Christopher A Dodoo, Arthur J De Luigi, Nikki L Branstiter, Quoc-Dien Trinh, Sarah P Psutka","doi":"10.1002/cncr.35608","DOIUrl":"https://doi.org/10.1002/cncr.35608","url":null,"abstract":"<p><p>The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a culturally tailored patient navigation program on unmet supportive care needs in Hispanic/Latino cancer survivors: A randomized controlled trial.","authors":"Blanca S Noriega Esquives, Patricia I Moreno, Edgar Munoz, Thomas E Lad, Courtney M P Hollowell, Roberto M Benzo, Amelie G Ramirez, Frank J Penedo","doi":"10.1002/cncr.35626","DOIUrl":"https://doi.org/10.1002/cncr.35626","url":null,"abstract":"<p><strong>Background: </strong>Patient navigation (PN) is a promising yet underused approach to address Hispanic/Latino (H/L) cancer survivors' unmet supportive care needs. The authors conducted a randomized trial to evaluate the effect of a culturally tailored PN program with the LIVESTRONG Foundation's Cancer Navigation Services (PN-LCNS) on reducing unmet needs in H/L survivors.</p><p><strong>Methods: </strong>From 2012 to 2015 at two US sites, 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer were randomized to a PN-LCNS program or to standard PN. Participants assigned to the PN-LCNS program received 3-month PN services; access to phone-based, bilingual, one-on-one support; and additional resources (i.e., guidebook, health journal, and care plan). Participants completed assessments at baseline and at 3, 9, and 15 months post-baseline. The Supportive Care Needs Survey was used to assess unmet needs across five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality. Intervention effects were tested by using separate multilevel growth models for women and men.</p><p><strong>Results: </strong>Women randomized to the PN-LCNS program, relative to those who received standard PN, had a statistically significant reduction in unmet needs (i.e., overall and for the health systems and information, physical and daily living, and patient care and support domains). Among men, younger age was associated with greater unmet needs at baseline. Prostate cancer survivors reported greater unmet sexual health needs compared with colorectal cancer survivors. There was no significant change in unmet needs among H/L men.</p><p><strong>Conclusions: </strong>A culturally tailored PN program can reduce unmet supportive care needs among H/L women cancer survivors. However, interventions specifically targeting unmet needs in H/L men and sexual health are still necessary (ClinicalTrials.gov identifier NCT02275754).</p><p><strong>Plain language summary: </strong>Hispanic/Latino (H/L) cancer survivors often report concerns or needs that are not adequately addressed by the health care team, which could be related to psychological, health system and information, patient care and support, physical and daily living, and sexuality issues. In this randomized controlled trial of 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer, women assigned to a culturally tailored patient navigation program experienced a reduction in unmet needs compared with those who received standard patient navigation. H/L men did not experience a change in unmet needs.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase 2, multicenter, clinical trial of CPX-351 in older patients with secondary or high-risk acute myeloid leukemia: PETHEMA-LAMVYX.","authors":"Eduardo Rodríguez-Arbolí, Rebeca Rodríguez-Veiga, Elena Soria-Saldise, Juan M Bergua, Teresa Caballero-Velázquez, Montserrat Arnán, Susana Vives, Josefina Serrano, Teresa Bernal, Pilar Martínez-Sánchez, Mar Tormo, Carlos Rodríguez-Medina, Pilar Herrera-Puente, Esperanza Lavilla-Rubira, Blanca Boluda, Evelyn Acuña-Cruz, Isabel Cano, Sara Cáceres, Juan Ballesteros, José Falantes, David Martínez-Cuadrón, José A Pérez-Simón, Pau Montesinos","doi":"10.1002/cncr.35618","DOIUrl":"https://doi.org/10.1002/cncr.35618","url":null,"abstract":"<p><strong>Background: </strong>LAMVYX was a multicenter, single-arm, phase 2 trial designed to validate the safety and efficacy of CPX-351 in patients aged 60-75 years with newly diagnosed, secondary acute myeloid leukemia and to generate evidence on key issues not addressed in the preceding regulatory pivotal trial.</p><p><strong>Methods: </strong>The primary end point of the study was the complete remission (CR)/CR with incomplete hematologic recovery (CRi) rate after induction. Eligible patients were recommended to undergo allogeneic hematopoietic stem cell transplantation after the first consolidation cycle. Alternatively, patients could undergo up to six maintenance cycles with CPX-351.</p><p><strong>Results: </strong>Twenty-nine patients (49%; 95% exact confidence interval [CI], 37%-62%) patients achieved a CR/CRi after one or two cycles of induction, with a measurable residual disease negativity rate of 67% as assessed by centralized, multiparameter flow cytometry. Among patients who had serial next-generation sequencing analyses available, clearance of somatic mutations that were present at diagnosis was achieved in 7 (35%). The median follow-up among survivors was 16.8 months (range, 8.7-24.3 months). The median event-free survival was 3.0 months (95% CI, 1.4-7.3 months), and the median overall survival was 7.4 months (95% CI, 3.7-12.7 months). In landmark analyses at day +100 from diagnosis, the 1-year overall and event-free survival rate among patients who underwent allogeneic hematopoietic stem cell transplantation was 70% (95% CI, 47%-100%) and 70% (95% CI, 47%-100%), respectively. The corresponding values were 89% (95% CI, 71%-100%) and 44% (95% CI, 21%-92%), respectively, for patients who entered the maintenance phase. No significant longitudinal changes were observed in severity index or quality-of-life visual analog scale scores.</p><p><strong>Conclusions: </strong>The current data provide novel insights that might inform the clinical positioning and optimal use of CPX-351, complementing previous results (ClinicalTrials.gov identifier NCT04230239).</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We can do better: Risk-based screening adherence in childhood cancer survivors.","authors":"Danielle Novetsky Friedman, Matthew J Ehrhardt","doi":"10.1002/cncr.35622","DOIUrl":"10.1002/cncr.35622","url":null,"abstract":"","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined analysis of the MF18-02/MF18-03 NEOSENTITURK studies: ypN-positive disease does not necessitate axillary lymph node dissection in patients with breast cancer with a good response to neoadjuvant chemotherapy as long as radiotherapy is provided.","authors":"Mahmut Muslumanoglu, Neslihan Cabioglu, Abdullah Igci, Hasan Karanlık, Havva Belma Kocer, Kazim Senol, Baris Mantoglu, Mustafa Tukenmez, Guldeniz Karadeniz Çakmak, Enver Ozkurt, Mehmet Ali Gulcelik, Selman Emiroglu, Baran Mollavelioglu, Nilufer Yildirim, Suleyman Bademler, Baha Zengel, Didem Can Trabulus, Mustafa Umit Ugurlu, Cihan Uras, Serkan Ilgun, Gokhan Giray Akgul, Alper Akcan, Serdar Yormaz, Yeliz Emine Ersoy, Serdar Ozbas, Ece Dilege, Bulent Citgez, Yasemin Bolukbasi, Ayse Altınok, Ahmet Dag, Gül Basaran, Nihat Zafer Utkan, Beyza Ozcinar, Cumhur Arici, Israa AlJorani, Halil Kara, Banu Yigit, Ebru Sen, Fazilet Erozgen, Aykut Soyder, Burak Celik, Halime Gul Kilic, Leyla Zer, Gürhan Sakman, Levent Yeniay, Kemal Atahan, Ecenur Varol, Vefa Veliyeva, Berk Goktepe, Mehmet Velidedeoglu, Niyazi Karaman, Atilla Soran, Adnan Aydiner, Ravza Yılmaz, Kamuran Ibis, Vahit Ozmen","doi":"10.1002/cncr.35610","DOIUrl":"https://doi.org/10.1002/cncr.35610","url":null,"abstract":"<p><strong>Background: </strong>The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.</p><p><strong>Methods: </strong>A joint analysis of two different multicenter cohorts-the retrospective cohort registry MF18-02 and the prospective observational cohort registry MF18-03 (NCT04250129)-was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.</p><p><strong>Results: </strong>Five hundred and one patients with cT1-4, N1-3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow-up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease-free survival (DFS) and disease-specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.</p><p><strong>Conclusions: </strong>The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}