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Does Neoadjuvant Chemotherapy in Clinical T1–T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?

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

Abstract

Background

Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1–2N0 TNBC.

Methods

The National Cancer Database (NCDB) was queried for women with operable cT1–2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND.

Results

Overall, 55,624 women were included: 26.9% (n = 14,942) underwent NAC and 73.1% (n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p < 0.001) with more cT2 tumors (71.6% vs. 31.0%; p < 0.001), and had lower ALND rates (4.3% vs. 5.5%; p < 0.001). The upfront surgery cohort was more likely to have one to three pathologically positive nodes (12.1% vs. 6.5%; odds ratio [OR] 2.37, 95% confidence interval (CI) 2.17–2.58; p < 0.001) but there was no difference in the likelihood of ALND (OR 1.1, 95% CI 0.99–1.24; p = 0.08).

Conclusion

Patients who underwent upfront surgery were more likely to be pN+; however, ALND rates were similar between the two cohorts. Thus, the use of NAC does not result in a higher odds of ALND and the decision for NAC should be individualized and based on modern guidelines and systemic therapy benefits.

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Funding

Chandler Cortina is supported by the National Institutes of Health (NIH) under Award No. 1K08CA276706-01A1 (Principal Investigator: CC). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Chandler S. Cortina MD, MS, FSSO, FACS, Christine Rogers BS, Morgan K. Johnson BS, Adrienne N. Cobb MD, MS & Amanda L. Kong MD, MS, FSSO, FACS

  2. Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA

    Chandler S. Cortina MD, MS, FSSO, FACS & Amanda L. Kong MD, MS, FSSO, FACS

  3. Division of Biostatistics, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA

    Jan Irene Lloren MPH, RN & Chiang-Ching Huang PhD

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

    Puneet Singh MD, CMQ, FSSO, FACS & Mediget Teshome MD, MPH, FSSO, FACS

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  1. Chandler S. Cortina MD, MS, FSSO, FACS
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Correspondence to Chandler S. Cortina MD, MS, FSSO, FACS.

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Disclosure

Mediget Teshome reports conference travel and accommodation from Endomag LTD (not relevant to this work). Chandler S. Cortina, Jan Irene Lloren, Christine Rogers, Morgan K. Johnson, Adrienne N. Cobb, Chiang-Ching Huang, Amanda L. Kong, Puneet Singh, and Mediget Teshome have no conflicts of interest to declare in relation to this work.

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Cortina, C.S., Lloren, J.I., Rogers, C. et al. Does Neoadjuvant Chemotherapy in Clinical T1–T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?. Ann Surg Oncol 31, 3128–3140 (2024). https://doi.org/10.1245/s10434-024-14914-9

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