Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
University of Michigan, Ann Arbor, MI, USA.
Ann Surg Oncol. 2022 Oct;29(10):6267-6273. doi: 10.1245/s10434-022-12193-w. Epub 2022 Jul 18.
The RxPONDER trial reported no benefit to chemotherapy among postmenopausal patients with HR/HER2 tumors, one to three positive nodes, and low recurrence scores, questioning the role of axillary staging in this population. Here, we evaluate the impact of sentinel lymph node biopsy (SLNB) results on adjuvant therapy decisions in postmenopausal women with HR/HER2 breast cancer.
Postmenopausal women with cT1-2N0, HR/HER2 breast cancer treated with lumpectomy and SLNB from 2012 to 2018 were identified. Receipt of nodal irradiation, indication for axillary lymph node dissection (ALND) and chemotherapy, and partial breast irradiation (PBI) eligibility were reviewed with pre- and post-SLNB results.
A total of 1786 women were identified: median age 62 years, 84% with pT1 tumors, and 16% with pT2-3 tumors. Of those, 85% (n = 1525) remained pN0, 14% (n = 244) were pN1, and 1% (n = 17) were pN2-3. A total of 20 (1%) patients had > 2 positive SLNs, necessitating ALND. Pre-SLNB, 1478 women were considered PBI eligible; post-SLNB, 227 (13%) converted to PBI ineligible. In total, 58 patients with positive nodes received nodal irradiation, representing 3% of the entire cohort and 22% of pN+ patients. Overall, 1401 patients had an Oncotype DX recurrence score available, including 1273 patients with pN0 stage and 128 with pN1, with 173 (14%) and 16 (13%), respectively, having a recurrence score > 25, warranting chemotherapy.
While few cN0 postmenopausal women with HR/HER2 tumors had nodal pathology that warranted ALND, receipt of nodal irradiation, or indicated need for chemotherapy, in 13%, SLNB would have an impact on consideration for PBI. Among patients eligible for PBI, findings from SLNB may help refine selection among postmenopausal women with this tumor profile.
RxPONDER 试验表明，对于 HR/HER2 阳性、淋巴结转移 1-3 个且复发评分低的绝经后患者，化疗无益，这对该人群的腋窝分期提出了质疑。在此，我们评估了前哨淋巴结活检（SLNB）结果对 HR/HER2 乳腺癌绝经后患者辅助治疗决策的影响。
回顾性分析 2012 年至 2018 年间接受保乳术和 SLNB 治疗的 HR/HER2 乳腺癌 cT1-2N0 绝经后患者。根据 SLNB 前和 SLNB 后的结果，评估了接受淋巴结照射、行腋窝淋巴结清扫术（ALND）和化疗的指征以及行部分乳房照射（PBI）的可能性。
共纳入 1786 例患者：中位年龄 62 岁，84%患者为 pT1 肿瘤，16%为 pT2-3 肿瘤。其中，85%（n=1525）患者为 pN0，14%（n=244）为 pN1，1%（n=17）为 pN2-3。共有 20 例（1%）患者的 SLN 阳性>2 个，需要行 ALND。在 SLNB 前，有 1478 例患者被认为有 PBI 适应证；SLNB 后，227 例（13%）患者转为 PBI 禁忌。共有 58 例有阳性淋巴结的患者接受了淋巴结照射，占总队列的 3%，pN+患者的 22%。总体而言，共有 1401 例患者有 Oncotype DX 复发评分，其中 1273 例 pN0 期患者和 128 例 pN1 患者，分别有 173 例（14%）和 16 例（13%）患者的复发评分>25，需要化疗。
尽管 HR/HER2 阳性肿瘤的绝经后 cN0 患者中很少有需要行 ALND、接受淋巴结照射或化疗的淋巴结病理，但 13%的患者 SLNB 结果可能会影响对 PBI 的考虑。在有 PBI 适应证的患者中，SLNB 的结果可能有助于细化对具有这种肿瘤特征的绝经后患者的选择。
