Clinical Significance of Axillary Microresiduals After Neoadjuvant Chemotherapy in Breast Cancer Patients with Cytologically Proven Metastases
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Neoadjuvant chemotherapy (NAC) has been widely accepted for advanced breast cancer patients, and pathological complete remission (pCR) was revealed to be an important prognostic factor. The pCR status of cytologically proven axillary metastases (ALN-pCR) offers a more powerful prognostic predictor than pCR of the main tumor. This study evaluated the clinical significance of residual micrometastases and discusses screening methods after NAC in patients with cytologically proven axillary metastases.
Eighty patients with a diagnosis of cytologically proven axillary metastases received NAC. All dissected lymph nodes were evaluated using multislice sectioning and cytokeratin immunohistochemistry, and categorized into four groups: no metastases (ALN-pCR), and with metastases ≤0.2 mm (ALN-itc), >0.2 mm but ≤2 mm (ALN-mic), and >2 mm (ALN-mac). Disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan–Meier method based on the status of residual metastases.
DFS in patients with ALN-pCR and ALN-itc was significantly longer than that with ALN-mic (P = 0.007, P = 0.045, respectively). OS with ALN-pCR was significantly longer than that with ALN-mic (P = 0.004). There was no significant difference in DFS or OS between ALN-mac and ALN-mic. These data showed the clinical significance of microresidual metastases >0.2 mm after NAC in patients with cytologically proven axillary metastases.
Using multislice sectioning, screening for ALN-mic after NAC was clinically important, and that for ALN-itc was not clinically essential.
- Hortobagyi GN, Blumenschein GR, Spanos W, et al. Multimodal treatmentof locoregionally advanced breast cancer. Cancer. 1983;51:763–8.
- Bonadonna G, Veronesi U, Brambilla C, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst. 1990;82:1539–45. CrossRef
- Scholl SM, Fourquet A, Asselain B, et al. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6. Eur J Cancer. 1994;30:645–52. CrossRef
- Bauer RL, Busch E, Levine E, et al. Therapy for inflammatory breast cancer: impact of doxorubicin-based therapy. Ann Surg Oncol. 1995;2:288–94. CrossRef
- Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15:2483–93.
- Hortobagyi GN. Treatment of breast cancer. N Engl J Med. 1998;339:974–84. CrossRef
- Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16:2672–85.
- Bonadonna G, Valagussa P, Brambilla C, et al. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol. 1998;16:93–100.
- Bear HD, Anderson S, Brown A, et al. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2003;21:4165–74. CrossRef
- Abrial SC, Penault-Llorca F, Delva R, et al. High prognostic significance of residual disease after neoadjuvant chemotherapy: a retrospective study in 710 patients with operable breast cancer. Breast Cancer Res Treat. 2005;94:255–63. CrossRef
- Bear HD, Anderson S, Smith RE, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24:2019–27. CrossRef
- Kuerer HM, Newman LA, Smith TL, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17:460–9.
- Rouzier R, Extra JM, Klijanienko J, et al. Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol. 2002;20:1304–10. CrossRef
- Hennessy BT, Hortobagyi GN, Rouzier R, et al. Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol. 2005;23:9304–11. CrossRef
- Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7. CrossRef
- Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer–a multicenter validation study. N Engl J Med. 1998;339:941–6. CrossRef
- Barnwell JM, Arredondo MA, Kollmorgen D, et al. Sentinel node biopsy in breast cancer. Ann Surg Oncol. 1998;5:126–30. CrossRef
- Dowlatshahi K, Fan M, Bloom KJ, et al. Occult metastases in the sentinel lymph nodes of patients with early stage breast carcinoma: A preliminary study. Cancer. 1999;86:990–6. CrossRef
- Cote RJ, Peterson HF, Chaiwun B, et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet. 1999;354:896–900.
- Cox CE. Clinical relevance of serial sectioning of sentinel nodes and the detection of micrometastatic nodal disease in breast cancer. Ann Surg Oncol. 1998;5:297–8. CrossRef
- Schreiber RH, Pendas S, Ku NN, et al. Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node. Ann Surg Oncol. 1999;6:95–101. CrossRef
- Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63:181–7. CrossRef
- Recht A, Houlihan MJ. Axillary lymph nodes and breast cancer: a review. Cancer. 1995;76:1491–512. CrossRef
- Jatoi I, Hilsenbeck SG, Clark GM, et al. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol. 1999;17:2334–40.
- McCready DR, Hortobagyi GN, Kau SW, et al. The prognostic significance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer. Arch Surg. 1989;124:21–5.
- Botti C, Vici P, Lopez M, et al. Prognostic value of lymph node metastases after neoadjuvant chemotherapy for large-sized operable carcinoma of the breast. J Am Coll Surg. 1995;181:202–8.
- Kuerer HM, Newman LA, Buzdar AU, et al. Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer. Am J Surg. 1998;176:502–9. CrossRef
- Pierga JY, Mouret E, Dieras V, et al. Prognostic value of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer. Br J Cancer. 2000;83:1480–7. CrossRef
- Curé H, Amat S, Penault-Llorca F, et al. Prognostic value of residual node involvement in operable breast cancer after induction chemotherapy. Breast Cancer Res Treat. 2002;76:37–45. CrossRef
- Loya A, Guray M, Hennessy BT, et al. Prognostic significance of occult axillary lymph node metastases after chemotherapy-induced pathologic complete response of cytologically proven axillary lymph node metastases from breast cancer. Cancer. 2009;115:1605–12. CrossRef
- Clinical Significance of Axillary Microresiduals After Neoadjuvant Chemotherapy in Breast Cancer Patients with Cytologically Proven Metastases
Annals of Surgical Oncology
Volume 16, Issue 9 , pp 2470-2478
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- 2. Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan