Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Breast Center, University Hospital of Basel, Basel, Switzerland.
Oncology. 2021;99(6):359-364. doi: 10.1159/000513454. Epub 2021 Mar 18.
Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients.
Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC.
A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2- tumors, 38% of HR+/HER2+ tumors, 49% of HR-/HER2+ tumors, and 42% of HR-/HER2-tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2- [referent]: OR 3.42, 95% CI 1.43-8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85-9.50, p = 0.001 for HR-/HER2+; and OR 2.94, 95% CI 1.11-7.74, p = 0.029 for HR-/HER2-), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29-36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09-39.18, p = 0.003).
This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.
新辅助化疗（NAC）越来越多地用于治疗淋巴结阳性（N+）乳腺癌。亚洲女性中预测淋巴结病理完全缓解（pCR）的因素描述不佳，且 NAC 后腋窝的处理方式也各不相同。我们评估了亚洲 N+患者队列中预测淋巴结 pCR 和腋窝处理的因素。
从中国上海瑞金医院确定了接受 NAC 治疗的活检证实的连续 N+乳腺癌患者。所有患者均行腋窝淋巴结清扫术，无论 NAC 对淋巴结的反应如何。
共纳入 323 例患者。105 例（33%）患者达到淋巴结 pCR，其中 HR+/HER2-肿瘤为 15%，HR+/HER2+肿瘤为 38%，HR-/HER2+肿瘤为 49%，HR-/HER2-肿瘤为 42%（p<0.001）。与淋巴结 pCR 相关的因素包括（1）受体状态（HR+/HER2-[参照]：OR 3.42，95%CI 1.43-8.16，p=0.006 用于 HR+/HER2+；OR 4.19，95%CI 1.85-9.50，p=0.001 用于 HR-/HER2+；和 OR 2.94，95%CI 1.11-7.74，p=0.029 用于 HR-/HER2-）；（2）乳房 pCR（无 pCR[参照]：OR 15.22，95%CI 6.29-36.79，p<0.001）；和（3）无脉管浸润（LVI[参照]：OR 9.04，95%CI 2.09-39.18，p=0.003）。
本研究证实了亚洲女性中预期的淋巴结 pCR 预测因素，以及 NAC 降低淋巴结和腋窝分期的作用与种族无关。
