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Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery

  • Epidemiology
  • Published:
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Abstract

Purpose

The goal of this study was to identify the preoperative predictors of pathologic nodal metastases (pN+) in cT1cN0 HER2+ breast cancer undergoing upfront surgery.

Methods

We retrospectively reviewed data from women with cT1-T2N0 HER2+ breast cancer treated with neoadjuvant therapy (NAC) or upfront surgery at our institution between 2012 and 2023. Factors associated with management strategy were evaluated, and in those undergoing upfront surgery, univariate analyses were performed to identify the clinicopathologic factors associated with nodal metastases.

Results

Overall, 255 women with cT1-T2N0 HER2+ breast cancer met inclusion criteria, including 170 (68.6%) upfront surgery patients and 85 (31.4%) who underwent NAC. The median age at diagnosis was 59 years (range, 27–90 years). Younger age, larger clinical tumor size, high-grade disease, ER-PR-HER2+ subtype, and year of diagnosis after 2019 were significantly associated with receipt of NAC (p < 0.05). In those undergoing upfront surgery, 25.3% were pN+ , including 32.5% of cT1cN0 tumors. Factors associated with nodal involvement included age under 50, larger clinical tumor size, lymphovascular invasion (LVI), multifocality/multicentricity, and abnormal lymph nodes on axillary ultrasound (p < 0.05). In subset analysis of cT1cN0 HER2+ cases, LVI remained the strongest predictor of pN + disease (73.3% vs. 22.6%, p < 0.001). Patients with cT1cN0 HER2+ breast cancer under 50 years had a 47.1% likelihood of pN+ disease.

Conclusion

Patients with cT1cN0 breast cancer have a 32.5% likelihood of nodal metastases, with higher incidence with younger age, LVI, multifocality/multicentricity, and abnormal axillary ultrasound. The presence of these factors may identify the patients who would benefit from treatment with neoadjuvant chemotherapy.

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Data availability

Anonymized data supporting the findings of this study may be available from the corresponding author upon reasonable request and subsequent institutional ethics board approval.

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Funding

This work was supported by award 309854 (to Stephanie M. Wong) from the Fonds de Recherche du Quebec Santé.

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Authors and Affiliations

  1. Department of Surgery, McGill University Medical School, Montreal, QC, Canada

    Sohayb Faleh, Ipshita Prakash, Haseeb Khan, Mark Basik, Jean Francois Boileau, David Tejera, Karyne Martel, Sarkis Meterissian & Stephanie M. Wong

  2. Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada

    Ipshita Prakash, Aida Salehi, Haseeb Khan, Mark Basik, Jean Francois Boileau, David Tejera, Francois Panet, Karyne Martel & Stephanie M. Wong

  3. Department of Oncology, McGill University Medical School, Montreal, QC, Canada

    Ipshita Prakash, Aida Salehi, Mark Basik, Jean Francois Boileau, Francois Panet, Sarkis Meterissian & Stephanie M. Wong

  4. McGill University Health Centre Cedars Breast Clinic, Montreal, QC, Canada

    Sohayb Faleh & Sarkis Meterissian

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  1. Sohayb Faleh
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by SF, AS, and HK. Data analyses were performed by SF and SW. The first draft of the manuscript was written by SF and SMW and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephanie M. Wong.

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Competing interests

Jean-Francois Boileau reports honoraria from Roche, Novartis, Genomic Health, Pfizer, Allergan, and Merck; personal fees from Roche, Genomic Health, NanoString Technologies, Pfizer, Eli Lilly, Novartis, and Merck; and travel support from Roche, GlaxoSmithKline, Novartis, Pfizer, and Lifecell outside the submitted work. The remaining authors made no disclosures.

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Faleh, S., Prakash, I., Salehi, A. et al. Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07251-8

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