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Factors Associated with Pathological Node Negativity in Inflammatory Breast Cancer: Are There Patients Who May be Candidates for a De-Escalation of Axillary Surgery?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Modified radical mastectomy (MRM), which includes axillary dissection, is the standard of care for inflammatory breast cancer (IBC). While more limited axillary staging after neoadjuvant chemotherapy (NAC) in clinically node-positive non-IBC has been increasingly adopted, the impact of these techniques in IBC is not clear. To inform patient selection for further study of limited axillary surgery, we aimed to describe the frequency and factors associated with pathological node-negativity (ypN0) in IBC.

Methods

Patients with IBC who received NAC and MRM were identified from a prospective institutional database (2004–2019). Binary logistic regression analyses were conducted to identify factors associated with ypN0.

Results

Of 453 patients, 189 (41.7%) had a post-NAC clinical nodal stage (ycN stage) of N0 (ycN1: 150, 33.1%; ycN2: 4, 0.9%; ycN3: 47, 10.4%; unknown: 63, 13.9%); 156 (34%) were ypN0. On multivariable analysis, higher tumor grade was not associated with ypN0 (odds ratio [OR] 1.59, 95% confidence interval [CI] 0.90–2.81, p =0.11). Compared with hormone receptor (HR)-negative/human epidermal growth factor receptor 2 (HER2)-negative tumors (n =113, 24.9%), HR-positive/HER2-negative tumors (n =169, 37.3%) had a trend toward less ypN0 (OR 0.55, 95% CI 0.29–1.02, p =0.06); HR-positive/HER2-positive tumors (n =79, 17.4%) were similar to HR-negative/HER2-negative tumors (OR 0.72, 95% CI 0.35–1.48, p =0.37); and HR-negative/HER2-positive tumors (n =92, 20.3%) were associated with increased ypN0 (OR 4.82, 95% CI 2.41–9.63, p <0.001). As ycN stage increased, the likelihood of ypN0 decreased compared with ycN0 patients (ycN1/2: OR 0.54, 95% CI 0.32–0.89, p =0.02; ycN3: OR 0.29, 95% CI 0.13–0.67, p =0.004).

Conclusions

One-third of patients with IBC who received NAC and MRM had pathologically negative nodes. Factors associated with ypN0 included ycN0 status and HR-negative/HER2-positive subtype. Large, prospective studies are needed to investigate the feasibility of alternative nodal evaluation strategies in IBC, with consideration to these subgroups.

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Acknowledgment

The authors appreciate the support from the Morgan Welch Inflammatory Breast Cancer Research Program and the State of Texas Rare and Aggressive Breast Cancer Research Program Grant.

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Authors and Affiliations

  1. Division of Surgery, Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Lauren M. Postlewait MD, Mediget Teshome MD, MPH, FACS, Sarah M. DeSnyder MD, FACS, Henry M. Kuerer MD, PhD, FACS, Isabelle Bedrosian MD, FACS & Anthony Lucci MD, FACS

  2. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mediget Teshome MD, MPH, FACS, Sarah M. DeSnyder MD, FACS, Bora Lim MD, Wendy A. Woodward MD, PhD, Naoto T. Ueno MD, PhD, FACP & Anthony Lucci MD, FACS

  3. Department of Breast Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bora Lim MD & Naoto T. Ueno MD, PhD, FACP

  4. Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wendy A. Woodward MD, PhD

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  1. Lauren M. Postlewait MD
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  2. Mediget Teshome MD, MPH, FACS
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Correspondence to Anthony Lucci MD, FACS.

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Postlewait, L.M., Teshome, M., DeSnyder, S.M. et al. Factors Associated with Pathological Node Negativity in Inflammatory Breast Cancer: Are There Patients Who May be Candidates for a De-Escalation of Axillary Surgery?. Ann Surg Oncol 27, 4603–4612 (2020). https://doi.org/10.1245/s10434-020-08891-y

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