Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy: Is it necessary?
oleh: Xuhui Guo, Jiao Zhang, Xilong Gong, Jia Wang, Hao Dai, Dechuang Jiao, Rui Ling, Yi Zhao, Hongjian Yang, Yunjiang Liu, Ke Liu, Jianguo Zhang, Dahua Mao, Jianjun He, Zhigang Yu, Yinhua Liu, Peifen Fu, Jiandong Wang, Hongchuan Jiang, Zuowei Zhao, Xingsong Tian, Zhongwei Cao, Kejin Wu, Ailin Song, Feng Jin, Zhimin Fan, Zhenzhen Liu
| Format: | Article |
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| Diterbitkan: | Elsevier 2024-02-01 |
Deskripsi
Aim:This study aims to identify suitable candidates for axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) among clinical N2 (cN2) triple-negative (TN) or HER2 positive (HER2+）breast cancer patients following neoadjuvant therapy（NAT）.Background: Despite the substantial axillary burden in cN2 breast cancer patients, high pathological response rates can be achieved with NAT in TN or HER2+ subtypes, thus enabling potential downstaging of axillary surgery.Methods: A retrospective analysis was conducted on data from the CSBrS-012 study, screening 709 patients with initial cN2, either HER2+ or TN subtype, from January 1, 2010 to December 31, 2020. The correlation between axillary pathologic complete response (pCR) (yPN0) and breast pCR was examined.Results: Among the 177 cN2 patients who achieved breast pCR through NAT, 138 (78.0 %) also achieved axillary pCR. However, in the 532 initial clinical N2 patients who did not achieve breast pCR, residual axillary lymph node metastasis persisted in 77.4 % (412/532) of cases. The relative risk of residual axillary lymph node metastasis in patients who did not achieve breast pCR was 12.4 (8.1–19.1), compared to those who did achieve breast pCR, P < 0.001.Conclusion: For cN2 TN or HER2+ breast cancer patients who achieve breast pCR following NAT, consideration could be given to downstaging and performing an axillary SLNB or TAD.