Yan Zhiyan, Wong Adele, Ng Ruey Pyng, Lee Yien Sien, Lim Mei En Annabelle, Leong Lester Chee Hao, Allen John, Lim Geok Hoon
Breast Department, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Gland Surg. 2022 May;11(5):788-794. doi: 10.21037/gs-22-7.
In breast cancer patients fulfilling the Z0011 trial criteria, axillary lymph node dissection (ALND) is reserved for patients with a high nodal burden of ≥3 metastatic nodes. In this group of patients, to avoid an ALND, neoadjuvant chemotherapy (NACT) could be given instead to achieve nodal pathological complete response (pCR). However, the benefit of NACT in achieving nodal pCR and avoiding ALND in this group of patients is unknown. We aimed to determine the nodal pCR rate in this group of patients who otherwise would have needed an ALND.
cT1-2N0 breast cancer patients, with histologically proven nodal metastasis, who underwent NACT were identified from a prospectively maintained database. The sonographic criteria of ≥3 abnormal nodes, which has been reported as highly predictive of high nodal burden, was then used to identify the high nodal burden group. Nodal pCR was determined based on the ALND following NACT.
Twenty-four patients with high nodal burden were identified. Mean age was 55.2 years. 91.7% had invasive ductal carcinoma and 29.2% had grade III cancer. 54.2% achieved nodal pCR which was associated with ypT (P=0.006). Nodal pCR was 75%, 70% and 30% in the triple negative, human epidermal growth factor receptor2 (HER2) positive and ER/PR+HER2- tumors, respectively.
In the postulated T1-2 breast cancer patients with high nodal burden, needing an upfront ALND, NACT could result in nodal pCR of 54.2%, with higher pCR in certain subtypes. Hence, to minimize ALND risk, NACT should be offered in this high nodal burden group.
在符合Z0011试验标准的乳腺癌患者中，腋窝淋巴结清扫术（ALND）仅适用于有≥3个转移淋巴结、淋巴结负荷高的患者。在这组患者中，为避免进行ALND，可给予新辅助化疗（NACT）以实现淋巴结病理完全缓解（pCR）。然而，NACT在这组患者中实现淋巴结pCR并避免ALND的益处尚不清楚。我们旨在确定这组原本需要进行ALND的患者的淋巴结pCR率。
从一个前瞻性维护的数据库中识别出接受NACT的cT1-2N0乳腺癌患者，这些患者经组织学证实有淋巴结转移。然后使用已被报道为淋巴结负荷高的高度预测指标的≥3个异常淋巴结的超声标准来识别高淋巴结负荷组。根据NACT后的ALND确定淋巴结pCR。
确定了24例高淋巴结负荷患者。平均年龄为55.2岁。91.7%为浸润性导管癌，29.2%为III级癌。54.2%实现了淋巴结pCR，这与ypT相关（P=0.006）。三阴性、人表皮生长因子受体2（HER2）阳性和ER/PR+HER2-肿瘤的淋巴结pCR分别为75%、70%和30%。
在假定的T1-2期乳腺癌高淋巴结负荷患者中，若需 upfront ALND，NACT可使淋巴结pCR率达到54.2%，某些亚型的pCR率更高。因此，为将ALND风险降至最低，应在这一高淋巴结负荷组中提供NACT。
