Ryu Jai Min, Choi Hee Jun, Park Eun Hwa, Kim Ji Young, Lee Young Joo, Park Seho, Lee Jeeyeon, Park Heung Kyu, Nam Seok Jin, Kim Seok Won, Lee Jun-Hee, Lee Jeong Eon
Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
J Breast Cancer. 2022 Apr;25(2):94-105. doi: 10.4048/jbc.2022.25.e17.
PURPOSE: We evaluated the relationship between breast pathologic complete response (BpCR) and axillary pathologic complete response (ApCR) after neoadjuvant chemotherapy (NACT) according to nodal burden at presentation. As the indications for NACT have expanded, clinicians have started clinical trials for the omission of surgery from the treatment plan in patients with excellent responses to NACT. However, the appropriate indications for axillary surgery omission after excellent NACT response remain unclear. METHODS: Data were collected from patients in the Korean Breast Cancer Society Registry who underwent NACT followed by surgery between 2010 and 2020. We analyzed pathologic axillary nodal positivity after NACT according to BpCR stratified by tumor subtype in patients with cT1-3/N0-2 disease at diagnosis. RESULTS: A total of 6,597 patients were identified. Regarding cT stage, 528 (9.5%), 3,778 (67.8%), and 1,268 (22.7%) patients had cT1, cT2, and cT3 disease, respectively. Regarding cN stage, 1,539 (27.7%), 2,976 (53.6%), and 1,036 (18.7%) patients had cN0, cN1, and cN2 disease, respectively. BpCR occurred in 21.6% (n = 1,427) of patients, while ApCR and pathologic complete response (ypCR) occurred in 59.7% (n = 3,929) and ypCR 19.4% (n = 1,285) of patients, respectively. The distribution of biologic subtypes included 2,329 (39.3%) patients with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative disease, 1,122 (18.9%) with HR-positive/HER2-positive disease, 405 (6.8%) with HR-negative/HER2-positive disease, and 2,072 (35.0%) with triple-negative breast cancer . Among the patients with BpCR, 89.6% (1,122/1,252) had ApCR. Of those with cN0 disease, most (99.0%, 301/304) showed ApCR. Among patients with cN1-2 disease, 86.6% (821/948) had ApCR. CONCLUSION: BpCR was highly correlated with ApCR after NACT. In patients with cN0 and BpCR, the risk of missing axillary nodal metastasis was low after NACT. Further research on axillary surgery omission in patients with cN0 disease is needed.
目的：我们根据初诊时的淋巴结负荷评估了新辅助化疗（NACT）后乳腺病理完全缓解（BpCR）与腋窝病理完全缓解（ApCR）之间的关系。随着NACT适应证的扩大，临床医生已开始针对对NACT反应良好的患者在治疗方案中省略手术的临床试验。然而，NACT反应良好后省略腋窝手术的合适适应证仍不明确。 方法：收集2010年至2020年间在韩国乳腺癌协会登记处接受NACT并随后接受手术的患者的数据。我们根据诊断时cT1-3/N0-2疾病患者的肿瘤亚型分层，分析了NACT后病理腋窝淋巴结阳性情况。 结果：共确定了6597例患者。关于cT分期，分别有528例（9.5%）、3778例（67.8%）和1268例（22.7%）患者患有cT1、cT2和cT3疾病。关于cN分期，分别有1539例（27.7%）、2976例（53.6%）和1036例（18.7%）患者患有cN0、cN1和cN2疾病。21.6%（n = 1427）的患者出现BpCR，而59.7%（n = 3929）的患者出现ApCR，19.4%（n = 1285）的患者出现ypCR。生物学亚型分布包括2329例（39.3%）激素受体（HR）阳性/人表皮生长因子受体2（HER2）阴性疾病患者、1122例（18.9%）HR阳性/HER2阳性疾病患者、405例（6.8%）HR阴性/HER2阳性疾病患者和2072例（35.0%）三阴性乳腺癌患者。在BpCR患者中，89.6%（1122/1252）出现ApCR。在cN0疾病患者中，大多数（99.0%，301/304）显示ApCR。在cN1-2疾病患者中，86.6%（821/948）出现ApCR。 结论：NACT后BpCR与ApCR高度相关。在cN0且BpCR的患者中，NACT后遗漏腋窝淋巴结转移的风险较低。需要对cN0疾病患者省略腋窝手术进行进一步研究。
Breast Cancer Res Treat. 2020-11
CA Cancer J Clin. 2020-9
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