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Prediction of axillary pathologic response with breast pathologic complete response after neoadjuvant chemotherapy

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Abstract

Purpose

Many breast cancer patients receive sentinel lymph node biopsy after neoadjuvant chemotherapy (NAC). We evaluated the axillary pathologic complete response (pCR) in relation to achievement of breast pCR.

Methods

We evaluated 1044 patients who were diagnosed with invasive breast cancer and were treated with NAC followed by curative surgery at the Samsung Medical Center between January 2008 and December 2016. The pathologic node-positive rates in breast pCR patients were compared for different breast cancer subtypes and clinical nodal stages.

Results

Axillary pCR was achieved in 51.9% of the patients after NAC. In this case, the axillary pCR was associated with a biologic subtype (P < 0.0001), initial clinical tumor stage (P < 0.0001), clinical nodal stage (P = 0.0071), and breast pCR (P < 0.0001). In particular, axillary pCR correlated more than 80% with breast pCR (87.1%) or clinical nodal stage N0 (81.0%). Patients with breast pCR had 96.4% axillary pCR in clinical nodal stage N0, 86.1% in N1, and 84.7% in N2/N3.

Conclusion

Our study may help to predict node-positive rates in patients with breast pCR after NAC according to clinical node stage. Patients with a high probability of achieving pCR might be suitable candidates for more minimal surgery.

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References

  1. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV (1997) Effect of preoperative chemotherapy on local–regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493

    Article  CAS  PubMed  Google Scholar 

  2. Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, Brown AM, Robidoux A, Margolese R, Kahlenberg MS, Paik S, Soran A, Wickerham DL, Wolmark N (2006) Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 24:2019–2027

    Article  CAS  PubMed  Google Scholar 

  3. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Kuerer HM, Bowling M, Flippo-Morton TS, Byrd DR, Ollila DW, Julian TB, McLaughlin SA, McCall L, Symmans WF, Le-Petross HT, Haffty BG, Buchholz TA, Nelson H, Hunt KK (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310:1455–1461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mittendorf EA, Caudle AS, Yang W, Krishnamurthy S, Shaitelman S, Chavez-MacGregor M, Woodward WA, Bedrosian I, Kuerer HM, Hunt KK (2014) Implementation of the American College of Surgeons Oncology Group z1071 trial data in clinical practice: is there a way forward for sentinel lymph node dissection in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy? Ann Surg Oncol 21:2468–2473

    Article  PubMed  Google Scholar 

  5. Rouzier R, Extra JM, Klijanienko J, Falcou MC, Asselain B, Vincent-Salomon A, Vielh P, Bourstyn E (2002) Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 20:1304–1310

    Article  PubMed  Google Scholar 

  6. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609

    Article  PubMed  Google Scholar 

  7. Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25:3657–3663

    Article  PubMed  Google Scholar 

  8. Green MC, Buzdar AU, Smith T, Ibrahim NK, Valero V, Rosales MF, Cristofanilli M, Booser DJ, Pusztai L, Rivera E, Theriault RL, Carter C, Frye D, Hunt KK, Symmans WF, Strom EA, Sahin AA, Sikov W, Hortobagyi GN (2005) Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 23:5983–5992

    Article  CAS  PubMed  Google Scholar 

  9. Tadros AB, Yang WT, Krishnamurthy S, Rauch GM, Smith BD, Valero V, Black DM, Lucci A Jr, Caudle AS, DeSnyder SM, Teshome M, Barcenas CH, Miggins M, Adrada BE, Moseley T, Hwang RF, Hunt KK, Kuerer HM (2017) Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery. JAMA Surg 152:665–670

    Article  PubMed  PubMed Central  Google Scholar 

  10. Barron AU, Hoskin TL, Day CN, Hwang ES, Kuerer HM, Boughey JC (2018) Association of low nodal positivity rate among patients with ERBB2-positive or triple-negative breast cancer and breast pathologic complete response to neoadjuvant chemotherapy. JAMA Surg. https://doi.org/10.1001/jamasurg.2018.2696

    Article  PubMed  Google Scholar 

  11. Boughey JC, McCall LM, Ballman KV, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Flippo-Morton T, Hunt KK (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260:608–614; discussion 614–616

  12. Broglio KR, Quintana M, Foster M, Olinger M, McGlothlin A, Berry SM, Boileau JF, Brezden-Masley C, Chia S, Dent S, Gelmon K, Paterson A, Rayson D, Berry DA (2016) Association of pathologic complete response to neoadjuvant therapy in HER2-positive breast cancer with long-term outcomes: a meta-analysis. JAMA Oncol 2:751–760

    Article  PubMed  Google Scholar 

  13. Vila J, Mittendorf EA, Farante G, Bassett RL, Veronesi P, Galimberti V, Peradze N, Stauder MC, Chavez-MacGregor M, Litton JF, Huo L, Kuerer HM, Hunt KK, Caudle AS (2016) Nomograms for predicting axillary response to neoadjuvant chemotherapy in clinically node-positive patients with breast cancer. Ann Surg Oncol 23:3501–3509

    Article  PubMed  Google Scholar 

  14. Kantor O, Sipsy LM, Yao K, James TA (2018) A predictive model for axillary node pathologic complete response after neoadjuvant chemotherapy for breast cancer. Ann Surg Oncol 25:1304–1311

    Article  PubMed  Google Scholar 

  15. Kim JY, Park HS, Kim S, Ryu J, Park S, Kim SI (2015) Prognostic nomogram for prediction of axillary pathologic complete response after neoadjuvant chemotherapy in cytologically proven node-positive breast cancer. Medicine (Baltim) 94:e1720

    Article  CAS  Google Scholar 

  16. Schipper RJ, Moossdorff M, Nelemans PJ, Nieuwenhuijzen GA, de Vries B, Strobbe LJ, Roumen RM, van den Berkmortel F, Tjan-Heijnen VC, Beets-Tan RG, Lobbes MB, Smidt ML (2014) A model to predict pathologic complete response of axillary lymph nodes to neoadjuvant chemo(immuno)therapy in patients with clinically node-positive breast cancer. Clin Breast Cancer 14:315–322

    Article  CAS  PubMed  Google Scholar 

  17. Cortazar P, Geyer CE Jr (2015) Pathological complete response in neoadjuvant treatment of breast cancer. Ann Surg Oncol 22:1441–1446

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. Hee Jun Choi and Jai Min Ryu equally contributed to this work.

Authors and Affiliations

  1. Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea

    Hee Jun Choi

  2. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Samsung Medical Center Cancer Hospital, Sungkyunkwan University School of Medicine, 5th Floor Breast-Endocrine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, South Korea

    Jai Min Ryu, Isaac Kim, Seok Jin Nam, Seok Won Kim, Jonghan Yu, Jeong Eon Lee & Se Kyung Lee

  3. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Se Kyung Lee

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  1. Hee Jun Choi
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Correspondence to Se Kyung Lee.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose in relation to the production of this study.

Ethical approval

This study adhered to ethical tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of Samsung Medical Center, Seoul, Korea (IRB File No. 2017-09-051).

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The need for informed consent was waived because of the low risk posed by this investigation.

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Choi, H.J., Ryu, J.M., Kim, I. et al. Prediction of axillary pathologic response with breast pathologic complete response after neoadjuvant chemotherapy. Breast Cancer Res Treat 176, 591–596 (2019). https://doi.org/10.1007/s10549-019-05214-y

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  • DOI: https://doi.org/10.1007/s10549-019-05214-y

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