Selena J An, Christine Hong Ngoc Che Thai, Sherin Ismail, Chris B Agala, Van Hoang, Timothy Feeney, Margaret Lillie, Amy Wheless, Julia M Selfridge, David W Ollila, Kristalyn K Gallagher, Lisa A Carey, Philip M Spanheimer
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Downstaging was defined as post-NET decrease in category.</p><p><strong>Results: </strong>We included 123 patients; the majority were cT2 (n = 59) or cT3 (n = 35), and cN0 (n = 81). Median age was 70.0 years (interquartile range 62.1-76.0). Forty-two patients (34.1%) were clinically node-positive. After NET, 73 (59.8%) underwent breast-conserving surgery. All patients underwent sentinel lymph node biopsy, and 12 (9.8%) underwent completion axillary lymph node dissection. In-breast downstaging was achieved in 51 (41.5%) patients, 1 (0.8%) had breast pCR, and 14 (11.4%) had breast upstaging. Axillary downstaging was achieved in 10 (23.8%), 6 patients (14.3%) had nodal pCR, and 14 (33.3%) had axillary upstaging. At 10-year follow-up, local recurrence was 1% and distant recurrence was 14%, while disease-free survival was 82%. After adjusting for demographic and clinical factors, age was the only characteristic associated with mortality (hazard ratio 1.07, 95% confidence interval 1.01-1.13).</p><p><strong>Conclusions: </strong>In HR+ BC treated with NET, long-term disease-free survival is good, although nodal pCR is uncommon for cN+ patients. Future studies are needed to elucidate optimal neoadjuvant systemic therapy and to delineate oncologically safe strategies to deescalate axillary management for residual microscopic disease.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nodal Response and Survival After Neoadjuvant Endocrine Therapy in Hormone Receptor-Positive Breast Cancer: 20-Year Experience from a Single Institution.\",\"authors\":\"Selena J An, Christine Hong Ngoc Che Thai, Sherin Ismail, Chris B Agala, Van Hoang, Timothy Feeney, Margaret Lillie, Amy Wheless, Julia M Selfridge, David W Ollila, Kristalyn K Gallagher, Lisa A Carey, Philip M Spanheimer\",\"doi\":\"10.1245/s10434-024-16059-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Axillary response to neoadjuvant endocrine therapy (NET) for the treatment of hormone receptor-positive breast cancer (HR+ BC) is not well-described. This study was designed to characterize nodal response after NET.</p><p><strong>Methods: </strong>Patients receiving NET followed by curative intent surgery at a comprehensive cancer center from 1998 to 2022 in a prospectively collected registry were included. Patients with distant metastasis were excluded. Primary outcome was nodal pathologic complete response (pCR). Downstaging was defined as post-NET decrease in category.</p><p><strong>Results: </strong>We included 123 patients; the majority were cT2 (n = 59) or cT3 (n = 35), and cN0 (n = 81). Median age was 70.0 years (interquartile range 62.1-76.0). Forty-two patients (34.1%) were clinically node-positive. After NET, 73 (59.8%) underwent breast-conserving surgery. All patients underwent sentinel lymph node biopsy, and 12 (9.8%) underwent completion axillary lymph node dissection. In-breast downstaging was achieved in 51 (41.5%) patients, 1 (0.8%) had breast pCR, and 14 (11.4%) had breast upstaging. 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引用次数: 0
摘要
简介:新辅助内分泌治疗(NET)治疗激素受体阳性乳腺癌(HR+ BC)的腋窝反应尚未得到很好的描述。本研究旨在描述NET治疗后的结节反应:方法:纳入1998年至2022年期间在一家综合癌症中心接受NET治疗并随后进行根治性手术的患者,这些患者是在一个前瞻性登记册中收集的。不包括远处转移患者。主要结果为结节病理完全反应(pCR)。下分期定义为NET后类别的减少:我们共纳入了123例患者,其中大多数为cT2(59例)或cT3(35例)和cN0(81例)。中位年龄为 70.0 岁(四分位间范围 62.1-76.0)。42名患者(34.1%)临床结节阳性。在接受 NET 治疗后,73 名患者(59.8%)接受了保乳手术。所有患者均接受了前哨淋巴结活检,12 名患者(9.8%)接受了完整的腋窝淋巴结清扫术。51例(41.5%)患者实现了乳房内下移,1例(0.8%)实现了乳房pCR,14例(11.4%)实现了乳房上移。10名患者(23.8%)实现了腋下分期,6名患者(14.3%)有结节pCR,14名患者(33.3%)有腋窝上移。在10年的随访中,局部复发率为1%,远处复发率为14%,无病生存率为82%。调整人口统计学和临床因素后,年龄是唯一与死亡率相关的特征(危险比1.07,95%置信区间1.01-1.13):结论:在接受NET治疗的HR+ BC患者中,尽管结节pCR在cN+患者中并不常见,但长期无病生存率良好。未来的研究需要阐明最佳的新辅助系统疗法,并确定肿瘤学上安全的策略,以便对残留的微小病灶进行腋窝降级治疗。
Nodal Response and Survival After Neoadjuvant Endocrine Therapy in Hormone Receptor-Positive Breast Cancer: 20-Year Experience from a Single Institution.
Introduction: Axillary response to neoadjuvant endocrine therapy (NET) for the treatment of hormone receptor-positive breast cancer (HR+ BC) is not well-described. This study was designed to characterize nodal response after NET.
Methods: Patients receiving NET followed by curative intent surgery at a comprehensive cancer center from 1998 to 2022 in a prospectively collected registry were included. Patients with distant metastasis were excluded. Primary outcome was nodal pathologic complete response (pCR). Downstaging was defined as post-NET decrease in category.
Results: We included 123 patients; the majority were cT2 (n = 59) or cT3 (n = 35), and cN0 (n = 81). Median age was 70.0 years (interquartile range 62.1-76.0). Forty-two patients (34.1%) were clinically node-positive. After NET, 73 (59.8%) underwent breast-conserving surgery. All patients underwent sentinel lymph node biopsy, and 12 (9.8%) underwent completion axillary lymph node dissection. In-breast downstaging was achieved in 51 (41.5%) patients, 1 (0.8%) had breast pCR, and 14 (11.4%) had breast upstaging. Axillary downstaging was achieved in 10 (23.8%), 6 patients (14.3%) had nodal pCR, and 14 (33.3%) had axillary upstaging. At 10-year follow-up, local recurrence was 1% and distant recurrence was 14%, while disease-free survival was 82%. After adjusting for demographic and clinical factors, age was the only characteristic associated with mortality (hazard ratio 1.07, 95% confidence interval 1.01-1.13).
Conclusions: In HR+ BC treated with NET, long-term disease-free survival is good, although nodal pCR is uncommon for cN+ patients. Future studies are needed to elucidate optimal neoadjuvant systemic therapy and to delineate oncologically safe strategies to deescalate axillary management for residual microscopic disease.
期刊介绍:
The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.