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Can we avoid axillary lymph node dissection in N2 breast cancer patients with chemo-sensitive tumours such as HER2 and TNBC?

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Abstract

Purpose

To find a group of cN2 patients or patients with high axillary burden who become ypN0 after neoadjuvant chemotherapy (NACT) and who may benefit from avoiding a lymphadenectomy.

Methods

A retrospective observational cohort study was conducted with 221 clinically staged N2 patients or patients with at least 3 suspicious lymph nodes found by ultrasound at diagnosis. The predictive factors for ypN0 analysed were age, MRI-determined tumour size, histological subtype, the Nottingham histologic grade, surrogate molecular subtype, ki-67 and vascular invasion when present. Clinical and radiological responses after NACT were also evaluated. Univariate and multivariate analyses by logistic regression were performed. Distant disease-free survival (DDFS) was calculated in relation to the status of the axillary lymph nodes after NACT.

Results

After NACT, 89 patients (40.3%) had axillary pathologic complete response (pCR) (ypN0) and 132 (59.7%) had residual axillary disease (ypN+). Molecular surrogate subtype, Ki-67 expression, and the clinical and radiological responses to NACT were the only independent factors associated with ypN0. Axillary pCR was observed more often in HER2-positive and triple-negative tumours than in luminal ones (OR 7.5 and 3.6, respectively). DDFS was 88.7% (95% CI 80.7–96.7%) for ypN0 and 56.2% (95% CI 32.1–80.3%) for ypN+ (p = 0.09).

Conclusions

In HER2-positive and triple-negative breast cancer patients staged as cN2 or with high axillary burden before NACT, a sentinel lymph node biopsy after NACT could be recommended if there is a clinical and radiological response.

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Acknowledgements

Michael Maudsley for language revision.

Funding

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Authors and Affiliations

  1. Multidisciplinary Breast Cancer Unit, Department of Gynecology, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Bellvitge Hospital, Ave. Feixa Llarga, sn., Hospitalet de Llobregat, 08970, Barcelona, Spain

    Amparo Garcia-Tejedor, Sergi Fernandez-Gonzalez, Eulalia Fernandez-Montolí, Miriam Campos, Maria J. Pla & Jordi Ponce

  2. Multidisciplinary Breast Cancer Unit, Department of Radiology, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Raul Ortega, Anna Guma, Sonia Pernas & Catalina Falo

  3. Multidisciplinary Breast Cancer Unit, Department of Oncology, Institut Català d’Oncología, Barcelona, Spain

    Miguel Gil-Gil, Agostina Stradella & Sabela Recalde

  4. Multidisciplinary Breast Cancer Unit, Department of Oncologic Radiotherapy, Institut Català d’Oncología, Barcelona, Spain

    Hector Perez-Montero, Evelyn Martinez & Maria Laplana

  5. Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Teresa Soler, Anna Petit & Isabel Catala

  6. Multidisciplinary Breast Cancer Unit, Department of Nuclear Medicine, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Maria Teresa Bajen & Ana Benitez

  7. Multidisciplinary Breast Cancer Unit, Department of Plastic and Restorative Surgery, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Diana Perez-Sildekova

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  1. Amparo Garcia-Tejedor
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  2. Sergi Fernandez-Gonzalez
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  3. Raul Ortega
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  4. Miguel Gil-Gil
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  9. Teresa Soler
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  20. Isabel Catala
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Corresponding author

Correspondence to Amparo Garcia-Tejedor.

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All the authors declare that we have no conflict of interest. The authors alone are responsible for the content and writing of the paper.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As a retrospective study, the patient did not receive any specific informed consent for the study. The patients signed the informed consent for the usual procedure.

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Garcia-Tejedor, A., Fernandez-Gonzalez, S., Ortega, R. et al. Can we avoid axillary lymph node dissection in N2 breast cancer patients with chemo-sensitive tumours such as HER2 and TNBC?. Breast Cancer Res Treat 185, 657–666 (2021). https://doi.org/10.1007/s10549-020-05970-2

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  • DOI: https://doi.org/10.1007/s10549-020-05970-2

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