Knape Nicole, Park Ji-Hye, Agala Chris B, Spanheimer Philip, Morrow Monica, Downs-Canner Stephanie, Baldwin Xavier L
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ann Surg Oncol. 2023 Feb;30(2):1042-1050. doi: 10.1245/s10434-022-12626-6. Epub 2022 Oct 10.
Breast cancer has significant biologic heterogeneity, which influences treatment decisions. We hypothesized that in postmenopausal women (≥ 50 years) with clinical T1-2, N0, hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer of special histology (mucinous, tubular, cribriform, papillary), information from sentinel lymph node biopsy (SLNB) may not change adjuvant therapy recommendations.
We constructed a cohort from the National Cancer Database of women aged ≥ 18 years with cT1-2 N0 HR+ HER2- invasive breast cancer. We calculated the frequency of nodal positivity by histology. We measured the frequency of N2/N3 disease, the distribution of Oncotype DX 21-gene assay recurrence score (ODX RS) across special histology by nodal status, and frequency of chemotherapy use by ODX RS and pathologic N stage.
In women with cN0 HR+/HER2- special histologic subtype breast cancer, the likelihood of pathologic nodal positivity is less than 5%, and 99.7% of patients had N0 or N1 disease. Among women aged ≥ 50 years with HR+/HER2- special histologic subtype breast cancer, there was low prevalence of high ODX RS > 25 in both N0 and N1 patients (7% overall). Receipt of chemotherapy correlated with Oncotype DX scores as anticipated, with the lowest use in women with a low/intermediate RS (from 2 to 6% for N0 and 6-24% for N1) and the highest use in women with high risk Oncotype scores (from 74 to 92%).
Our study suggests that SLNB could potentially be omitted in select postmenopausal women with cT1-2 N0 HR+/HER2- special histologic subtype breast cancer when ODX RS is available.
乳腺癌具有显著的生物学异质性，这会影响治疗决策。我们假设，对于年龄≥50岁、临床分期为T1-2、N0、激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）且组织学类型特殊（黏液性、管状、筛状、乳头状）的绝经后女性乳腺癌患者，前哨淋巴结活检（SLNB）的结果可能不会改变辅助治疗的建议。
我们从国家癌症数据库中构建了一个队列，纳入年龄≥18岁、cT1-2 N0 HR+ HER2-浸润性乳腺癌女性患者。我们计算了不同组织学类型的淋巴结转移阳性率。我们测量了N2/N3期疾病的发生率、根据淋巴结状态在特殊组织学类型中Oncotype DX 21基因检测复发评分（ODX RS）的分布情况，以及根据ODX RS和病理N分期的化疗使用频率。
在cN0 HR+/HER2-特殊组织学亚型乳腺癌女性患者中，病理淋巴结转移阳性的可能性小于5%，99.7%的患者为N0或N1期疾病。在年龄≥50岁的HR+/HER2-特殊组织学亚型乳腺癌女性患者中，N0和N1期患者中ODX RS>25的高评分发生率较低（总体为7%）。化疗的使用与预期的Oncotype DX评分相关，低/中复发评分的女性患者使用率最低（N0患者为2%至6%，N1患者为6%至24%），高风险Oncotype评分的女性患者使用率最高（74%至92%）。
我们的研究表明，对于部分cT1-2 N0 HR+/HER2-特殊组织学亚型的绝经后乳腺癌女性患者，如果有ODX RS结果，可能无需进行SLNB。
