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Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer

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Abstract

Introduction

Studies support omission of axillary lymph node dissection (ALND) for patients with sentinel node-positive disease, with ALND recommended for patients who present with clinically positive nodes. Here, we evaluate patient and tumor characteristics and pathologic nodal stage of patients with estrogen receptor-positive (ER +) breast cancer who undergo ALND to determine if differences exist based on nodal presentation.

Materials and methods

Retrospective chart review from 2010 to 2019 defined three groups of patients with ER + breast cancer who underwent ALND for positive nodes: SLN + (positive node identified at SLN biopsy), cNUS (abnormal preoperative US and biopsy), and cNpalp (palpable adenopathy). Patients who received neoadjuvant chemotherapy or presented with axillary recurrence were excluded.

Results

Of 191 patients, 94 were SLN + , 40 were cNUS, and 57 were cNpalp. Patients with SLN + compared with cNpalp were younger (56 vs 64 years, p < 0.01), more often pre-menopausal (41% vs 14%, p < 0.01), and White (65% vs 39%, p = 0.01) with more tumors that were low-grade (36% vs 8%, p < 0.01). Rates of PR + (p = 0.16), levels of Ki67 expression (p = 0.07) and LVI (p = 0.06) did not differ significantly among groups. Of patients with SLN + disease, 64% had pN1 disease compared to 38% of cNUS (p = 0.1) and 40% of cNpalp (p = 0.01). On univariable analysis, tumor size (p = 0.01) and histology (p = 0.04) were significantly associated with pN1 disease, with size remaining an independent predictor on multivariable analysis (p = 0.02).

Conclusion

Historically, higher risk features have been attributed to patients with clinically positive nodes precluding omission of ALND, but when restricting evaluation to patients with ER + breast cancer, only tumor size is associated with higher nodal stage.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by Clinical and Translational Science Institute (CTSI) Grant No. UL1TR000124UCLA. Dr. Linda Ye is supported in part by the HH Lee Research Program.

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Authors and Affiliations

  1. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Linda Ye, Stephanie A. Angarita, Joseph Hadaya, Jennifer L. Baker, Carlie K. Thompson & Deanna J. Attai

  2. Statistics Core, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Dennis Rünger

  3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Minna K. Lee

  4. Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA

    Maggie L. DiNome

Authors
  1. Linda Ye
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  2. Dennis Rünger
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  3. Stephanie A. Angarita
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Correspondence to Maggie L. DiNome.

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The authors declare that they have no conflicts of interest.

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This study was reviewed and approved by the UCLA Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Ye, L., Rünger, D., Angarita, S.A. et al. Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer. Breast Cancer Res Treat 193, 429–436 (2022). https://doi.org/10.1007/s10549-022-06581-9

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  • DOI: https://doi.org/10.1007/s10549-022-06581-9

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