Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Ann Surg Oncol. 2019 Oct;26(11):3502-3509. doi: 10.1245/s10434-019-07517-2. Epub 2019 Jun 21.
The prognostic significance of low-volume residual nodal disease following neoadjuvant chemotherapy (NAC) is unknown.
Women with cT1-4N0-1 breast cancer treated with NAC were identified from Dana-Farber/Brigham and Women's Cancer Center (DFBWCC) and the National Cancer Database (NCDB). Disease-free survival (DFS) and overall survival (OS) estimates according to pathologic nodal status were calculated using the Kaplan-Meier method, with Cox proportional hazards regression used to assess the effect of clinical variables on survival outcomes.
Among 967 DFBWCC patients, 27 (2.8%) had residual isolated tumor cells (ITCs) and 61 (6.3%) had micrometastases. Five-year DFS was significantly worse in those with residual ITCs (73.5%) and micrometastases (74.7%) relative to those who were ypN0 following NAC (88.4%, p < 0.001). On adjusted analysis, those with residual ITCs (hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.20-3.81) and micrometastases (HR 2.14, 95% CI 1.20-3.81) had increased risk of recurrence relative to ypN0 patients. Among 35,536 NCDB patients, 543 (1.5%) had ITCs and 1132 (3.2%) had micrometastases. Five-year OS estimates were significantly worse with increasing residual nodal burden: ypN0, 88.9%; ypN0[i+], 82.8%; ypN1mi, 79.5%; ypN1, 77.6% (p < 0.001). Compared with patients with ypN0 disease, NCDB patients with ITCs and micrometastases had 1.9- and 2.2-fold risk of death (p < 0.001). On subgroup analysis, the effect of low-volume residual disease on mortality was most pronounced in patients with triple-negative and human epidermal growth factor receptor 2 (HER2)-positive disease.
Low-volume residual nodal disease following NAC is associated with poorer DFS and OS relative to those who are node negative.
新辅助化疗（NAC）后低残留淋巴结疾病的预后意义尚不清楚。
从达纳-法伯/布莱根妇女癌症中心（DFBWCC）和国家癌症数据库（NCDB）中确定了接受 NAC 治疗的 cT1-4N0-1 期乳腺癌女性。使用 Kaplan-Meier 法计算根据病理淋巴结状态的无病生存（DFS）和总生存（OS）估计值，使用 Cox 比例风险回归评估临床变量对生存结果的影响。
在 967 名 DFBWCC 患者中，27 名（2.8%）有残留的孤立肿瘤细胞（ITC），61 名（6.3%）有微转移。与 NAC 后 ypN0 的患者相比，残留 ITC（73.5%）和微转移（74.7%）的患者 5 年 DFS 明显更差（p<0.001）。在调整分析中，残留 ITC（危险比 [HR] 2.4，95%置信区间 [CI] 1.20-3.81）和微转移（HR 2.14，95% CI 1.20-3.81）的患者与 ypN0 患者相比，复发风险增加。在 35536 名 NCDB 患者中，543 名（1.5%）有 ITC，1132 名（3.2%）有微转移。随着残留淋巴结负荷的增加，5 年 OS 估计值明显更差：ypN0，88.9%；ypN0[i+]，82.8%；ypN1mi，79.5%；ypN1，77.6%（p<0.001）。与 ypN0 疾病患者相比，NCDB 患者中 ITC 和微转移的死亡风险分别增加 1.9 倍和 2.2 倍（p<0.001）。在亚组分析中，低残留量疾病对死亡率的影响在三阴性和人表皮生长因子受体 2（HER2）阳性疾病患者中最为明显。
与淋巴结阴性患者相比，NAC 后低残留淋巴结疾病与较差的 DFS 和 OS 相关。
