Laot Lucie, Laas Enora, Girard Noemie, Dumas Elise, Daoud Eric, Grandal Beatriz, Pierga Jean-Yves, Coussy Florence, Kirova Youlia, El-Alam Elsy, Bataillon Guillaume, Lae Marick, Llouquet Florence, Reyal Fabien, Hamy Anne-Sophie
Department of Surgical Oncology, Institute Curie, University Paris, 75005 Paris, France.
Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, INSERM, University Paris, 75005 Paris, France.
Cancers (Basel). 2021 Jan 6;13(2):171. doi: 10.3390/cancers13020171.
The three different breast cancer subtypes (Luminal, positive, and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype.
We retrospectively evaluated the axillary involvement (0, 1 to 3 positive nodes, ≥4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into three classes (0; 1 to 3; 4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes.
1197 patients were included in the analysis (luminal ( = 526, 43.9%), TNBCs ( = 376, 31.4%), -positive BCs ( = 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype ( = 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR 2.8; 95% CI [1.93; 4.06], < 0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR = 1.24, 95% CI = [0.86; 1.79]). In patients with TNBC, both 1-3N+ and ≥4 N+ classes were associated with a decreased RFS (HR = 3.19, 95% CI = [2.05; 4.98] and HR = 4.83, 95% CI = [3.06; 7.63], respectively ypN0, < 0.001). Similar decreased prognosis were observed among patients with -positive BC (1-3N +: HR = 2.7, 95% CI = [1.64; 4.43] and ≥4 N +: HR = 2.69, 95% CI = [1.24; 5.8] respectively, = 0.003).
The prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.
三种不同的乳腺癌亚型（管腔型、阳性型和三阴性乳腺癌（TNBC））表现出不同的自然病程和对治疗的敏感性，但对于新辅助化疗（NAC）后腋窝残留疾病是否因乳腺癌亚型而具有不同的预后价值，人们知之甚少。
我们回顾性评估了2002年至2012年间接受NAC治疗的T1-T3NxM0乳腺癌患者队列手术标本上的腋窝受累情况（0个、1至3个阳性淋巴结、≥4个阳性淋巴结）。我们分析了分为三类（0；1至3；4个或更多）的淋巴结受累情况（ypN）与总体人群以及根据乳腺癌亚型的无复发生存期（RFS）和总生存期（OS）之间的关联。
1197例患者纳入分析（管腔型（n = 526，43.9%），TNBC（n = 376，31.4%），阳性乳腺癌（n = 295，24.6%））。中位随访110.5个月后，ypN与RFS显著相关，但这种影响因乳腺癌亚型而异（P = 0.004），且这种影响是非线性的。在管腔型亚组中，与ypN0相比，4个或更多淋巴结受累的患者RFS受损（HR 2.8；95%CI[1.93；4.06]，P < 0.001），而1至3个淋巴结受累的患者则未受损（HR = 1.24，95%CI = [0.86；1.79]）。在TNBC患者中，1-3N+和≥4 N+类别均与RFS降低相关（HR = 3.19，95%CI = [2.05；4.98]和HR = 4.83，95%CI = [3.06；7.63]，分别对比ypN0，P < 0.001）。在阳性乳腺癌患者中也观察到类似的预后降低情况（1-3N +：HR = 2.7，95%CI = [1.64；4.43]和≥4 N +：HR = 2.69，95%CI = [1.24；5.8]，分别为P = 0.003）。
应在三种乳腺癌亚型中不同地考虑腋窝残留疾病的预后价值，以便准确分层NAC后复发风险高且应接受二线治疗的患者。
