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. 2021 May:261:67-73.
doi: 10.1016/j.jss.2020.12.007. Epub 2021 Jan 6.

Impact of Breast Cancer Pretreatment Nodal Burden and Disease Subtype on Axillary Surgical Management

Stephanie Ng  1 , Michael S Sabel  1 , Tasha M Hughes  1 , Alfred E Chang  1 , Lesly A Dossett  1 , Jacqueline S Jeruss  2
Affiliations

Impact of Breast Cancer Pretreatment Nodal Burden and Disease Subtype on Axillary Surgical Management

Stephanie Ng et al. J Surg Res. 2021 May.

Abstract

Background: The management of clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC) has progressed with the potential to avoid the morbidity of axillary lymph node dissection in patients with complete response to therapy. This study addresses the impact of pretreatment nodal burden and tumor subtype on axillary pathologic complete response (AXpCR) in patients treated with NAC to better inform axillary surgical management.

Methods: A prospective database was reviewed to identify clinically node-positive patients who underwent NAC followed by axillary lymph node dissection. Patients were stratified in accordance with abnormal nodal burden on pretreatment axillary imaging defined as low (1-2 nodes) or high (≥3 nodes), and biologic subtype defined by hormone receptor (HR+, HR-) and HER2 (human epidermal growth factor receptor 2) status. The primary outcome was AXpCR.

Results: AXpCR was 43% in the study population. There was no difference in AXpCR between low and high nodal burden groups (44% versus 42%, P = 0.87). Subtype correlated to AXpCR (P < 0.001) with the highest rate (78%) in the HR-/HER2+ group. Overall, HER2+ patients had a significantly higher AXpCR than HER2- subtypes (66% versus 28% P < 0.001). HR and HER2 status were also predictive of AXpCR when comparing patient, tumor, and treatment variables.

Conclusions: Biologic subtype better correlated with rates of AXpCR than nodal burden alone with the highest rates of AXpCR in HER2+ patients. Consideration of tumor biology is more informative than nodal burden when evaluating options for axillary management after NAC.

Keywords: ALND; Breast cancer; HER2; Neoadjuvant; Nodal burden; Targeted axillary dissection.

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Conflict of interest statement

Disclosure

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Figures

Fig. 1 –
Fig. 1 –
Criteria for patient selection of the study population.
Fig. 2 –
Fig. 2 –
Rates (%) of AXpCR stratified by nodal burden, subtype, and HER2 status across the study population.
See this image and copyright information in PMC

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