School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.
Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Ji Yan Road 440, Jinan, Shandong Province, People's Republic of China.
Breast Cancer. 2019 May;26(3):373-377. doi: 10.1007/s12282-018-00934-3. Epub 2019 Jan 21.
This study aims to determine the optimal time to perform sentinel lymph node biopsy (SLNB) for patients with clinically node-negative (cN) disease following neoadjuvant chemotherapy (NAC).
From April 2008 to April 2018, 592 patients with breast cancer underwent after NAC were included in this study. Patients with cN before and ycN disease after NAC received SLNB and axillary lymph node dissection (ALND) in case of positive sentinel lymph nodes (SLNs). For patients with clinically node-positive (cN) disease, the axillary surgery is based on the doctor's decision.
In general, 17.6% (104/592) of patients achieved total pathologic complete response (pCR), which was 6.9%, 33.3%, 32.3% and 15.3%, respectively, among patients with hormone receptor (HR) positive/ human epidermal growth factor receptor-2 (HER-2) negative (HR+/HER2-) subtype, triple-negative (TN) subtype, HER-2 positive (HER2+) subtype with and without targeted therapy (p < 0.001). Among the 525 cN patients, the axillary nodal pCR (apCR) rate was 34.5%, and the apCR rate was significantly higher in patients with HER2+ (58.6% with and 28.2% without targeted therapy respectively) and TN subtype (53.2%) than that in patients with HR+/HER2-subtype (21.2%, p < 0.001). Among the 67 cN patients, the positive rate of SLNs was 19.4% (13/67), which was 28.1% (9/32), 13.3% (2/15) and 10.0% (2/20), respectively, among patients with HR+/HER2-, TN and HER2 + subtypes.
The pCR rates were significantly related to molecular subtype. Combining the apCR rates in different molecular subtypes of cN patients and the excellent locoregional control of AOSOG Z0011 and AMAROS trials in cN patients, it would be preferable to perform SLNB prior to NAC for cN patients with HR+/HER2- subtype, and SLNB after NAC for those cN patients with TN and HER2+ subtype to increase the chance of avoiding ALND. Among cN patients, TN and HER2 + subtypes would benefit more from axillary de-escalating surgery after NAC than HR+/HER2- subtype.
本研究旨在确定新辅助化疗（NAC）后临床淋巴结阴性（cN）疾病患者行前哨淋巴结活检（SLNB）的最佳时间。
2008 年 4 月至 2018 年 4 月，592 例接受 NAC 后的乳腺癌患者纳入本研究。新辅助化疗前 cN 患者和 ycN 疾病患者在 SLN 阳性时接受 SLNB 和腋窝淋巴结清扫术（ALND）。对于临床淋巴结阳性（cN）疾病患者，根据医生的决定进行腋窝手术。
总体而言，17.6%（104/592）的患者达到完全病理缓解（pCR），其中激素受体（HR）阳性/人表皮生长因子受体-2（HER-2）阴性（HR+/HER2-）亚型、三阴性（TN）亚型、HER-2 阳性（HER2+）亚型且有或无靶向治疗的患者 pCR 率分别为 6.9%、33.3%、32.3%和 15.3%（p<0.001）。在 525 例 cN 患者中，腋窝淋巴结 pCR（apCR）率为 34.5%，HER2+（有和无靶向治疗的分别为 58.6%和 28.2%）和 TN 亚型（53.2%）患者的 apCR 率显著高于 HR+/HER2-亚型（21.2%，p<0.001）。在 67 例 cN 患者中，SLN 阳性率为 19.4%（13/67），其中 HR+/HER2-、TN 和 HER2+ 亚型患者的阳性率分别为 28.1%（9/32）、13.3%（2/15）和 10.0%（2/20）。
pCR 率与分子亚型显著相关。结合不同 cN 患者分子亚型的 apCR 率以及 AOSOG Z0011 和 AMAROS 试验在 cN 患者中优异的局部区域控制效果，如果 HR+/HER2-亚型 cN 患者在接受 NAC 前进行 SLNB，TN 和 HER2+亚型 cN 患者在接受 NAC 后进行 SLNB，可能会增加避免 ALND 的机会。在 cN 患者中，TN 和 HER2+亚型比 HR+/HER2-亚型从 NAC 后腋窝降级手术中获益更多。
