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Axillary Staging Is Not Justified in Postmenopausal Clinically Node-Negative Women Based on Nodal Disease Burden

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

Abstract

Background

RxPONDER showed no benefit of adjuvant chemotherapy in postmenopausal women with estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer and limited nodal burden (pN1) with a recurrence score ≤ 25, suggesting that axillary staging could be omitted in cN0 patients if significant numbers of such women do not have pN2–3 disease. Here we evaluate the pN2–3 disease rate in a large cohort of postmenopausal women presenting with cN0 breast cancer.

Patients and Methods

Consecutive postmenopausal patients presenting with T1–2N0 breast cancer who underwent axillary surgery from February 2006 to December 2011 were identified. Clinicopathologic characteristics associated with pN2–3 disease were examined using chi-square or Fisher’s exact tests.

Results

Of 3363 postmenopausal women with cT1–2N0 breast cancer (median age 58 years, IQR 48–67 years), median tumor size was 1.3 cm (IQR 0.90–1.90cm). Post-axillary staging, 2600 (77.3%) were pN0, 643 (19.1%) were pN1, and 120 (3.6%) were pN2–3. The pN2-3 disease rate did not differ across subtypes (4.4% HER2+, 3.5% HR−/HER2−, 3.5% HR+/HER2−, p = 0.70). In the subset with HR+/HER2− tumors, on multivariable analysis, age < 65 years (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.32–4.49), lymphovascular invasion (OR 5.29, 95% CI 2.72–11.2), multifocal/centric tumors (OR 3.08, 95% CI 1.79–5.32), and tumor size > 2 cm (OR 5.51, 95% CI 3.05–10.4) were significantly associated with pN2–3 nodal burden. Of 506 patients with tumors > 2 cm, 49 (9.7%) had pN2–3 disease; in the subset of 90 patients age < 65 years who had multifocal/centric tumors > 2 cm, 23 (25.6%) had pN2–3 disease.

Conclusions

In postmenopausal women with cN0 disease, pN2–3 nodal burden is uncommon; omitting axillary staging would not miss a significant number of patients who might benefit from adjuvant chemotherapy. Information available preoperatively indicating a higher risk of nodal disease such as younger age and large, multifocal tumors should be considered in the multidisciplinary management of the axilla.

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Acknowledgment

This study was presented in oral format at the SSO 2022 International Conference on Surgical Cancer Care, 9–12 March 2022, Dallas, TX.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Minna K. Lee MD, Giacomo Montagna MD, Melissa L. Pilewskie MD & Monica Morrow MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu MBBSPhD

Authors
  1. Minna K. Lee MD
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  2. Giacomo Montagna MD
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  3. Melissa L. Pilewskie MD
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  4. Varadan Sevilimedu MBBSPhD
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  5. Monica Morrow MD
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Corresponding author

Correspondence to Monica Morrow MD.

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Disclosure

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center. Dr. Monica Morrow has received honoraria from Roche and Exact Sciences. All other authors have no conflicts of interest to disclose.

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Lee, M.K., Montagna, G., Pilewskie, M.L. et al. Axillary Staging Is Not Justified in Postmenopausal Clinically Node-Negative Women Based on Nodal Disease Burden. Ann Surg Oncol 30, 92–97 (2023). https://doi.org/10.1245/s10434-022-12203-x

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  • DOI: https://doi.org/10.1245/s10434-022-12203-x

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