Kaur Mandeep, Dimitroff Katrina, Boughey Judy C, Esserman Laura J, Yau Christina, Tchou Julia, Quirarte Astrid, Lee Marie Catherine, Howard-McNatt Marissa M, Switalla Kayla, Kuerer Henry, Sauder Candice, Postlewait Lauren M, Arciero Cletus, Rao Roshni, Wallace Anne, Reyna Chantal, Ahmed Kamran, Gutnik Lily, Taunk Neil, Perlmutter Jane, DeMichele Angela, Yee Douglas, Hylton Nola M, Symmans W Fraser, Rugo Hope S, Shatsky Rebecca A, Isaacs Claudine, Rudra Sonali, Pohlmann Paula, Ewing Cheryl, Wong Jasmine, Alvarado Michael, Jaskowiak Nora, Prionas Nicolas, Golshan Mehra, Piltin Mara A, Olopade Olufunmilayo I, Mukhtar Rita A
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
University of California San Francisco, San Francisco, CA, USA.
Ann Surg Oncol. 2025 Jul 23. doi: 10.1245/s10434-025-17864-y.
Neoadjuvant chemotherapy (NAC) may allow de-escalation of axillary surgery; yet treatment disparities persist. We aimed to assess race-based disparities in use of axillary lymph node surgery (ALND) among patients who achieve a nodal response in the context of a large, multicenter NAC trial.
We conducted a retrospective analysis of the I-SPY 2 trial. All patients received NAC, but type of surgery was not mandated. Multivariable logistic regression was used to predict odds ratio (OR) of undergoing ALND by race while adjusting for clinical and demographic confounders, including age, region, tumor receptor subtype, clinical and pathologic node status (cN and ypN +/-, respectively), and clinical and pathologic tumor size (cT and ypT, respectively).
Among 1394 patients, 79.4% identified as White, 11.2% Black, and 9.4% Asian/other. More than half (52.5%) were cN+ at baseline, and 66.9% were ypN- after NAC, with no significant differences in nodal downstaging by race. Overall ALND rates were higher in Black patients (50.6%) compared to White (37.5%) and Asian/other (38.9%) patients (p = 0.007). Notably, among those who converted from cN+ to ypN-, Black patients underwent ALND more frequently (62%) than White (41.2%) and Asian/other (40%) patients (p = 0.021). In multivariable analysis, Black patients had 70% higher odds of undergoing ALND compared with White patients (OR 1.7, 95% confidence interval (CI) 1.09-2.66, p = 0.02).
Despite no differences in nodal downstaging, Black patients in I-SPY 2 were significantly more likely to undergo ALND. These disparities may stem from unmeasured patient, provider, or systemic factors affecting surgical planning.
新辅助化疗（NAC）可能允许降低腋窝手术的范围；然而治疗差异仍然存在。我们旨在评估在一项大型多中心NAC试验中，在实现淋巴结反应的患者中，基于种族的腋窝淋巴结手术（ALND）使用差异。
我们对I-SPY 2试验进行了回顾性分析。所有患者均接受NAC，但手术类型未作规定。多变量逻辑回归用于预测按种族进行ALND的比值比（OR），同时调整临床和人口统计学混杂因素，包括年龄、地区、肿瘤受体亚型、临床和病理淋巴结状态（分别为cN和ypN +/ -）以及临床和病理肿瘤大小（分别为cT和ypT）。
在1394例患者中，79.4%为白人，11.2%为黑人，9.4%为亚洲人/其他种族。超过一半（52.5%）的患者基线时cN+，NAC后66.9%为ypN-，按种族进行淋巴结降期无显著差异。黑人患者的总体ALND率（50.6%）高于白人（37.5%）和亚洲人/其他种族患者（38.9%）（p = 0.007）。值得注意的是，在那些从cN+转为ypN-的患者中，黑人患者接受ALND的频率（62%）高于白人（41.2%）和亚洲人/其他种族患者（40%）（p = 0.021）。在多变量分析中，黑人患者接受ALND的几率比白人患者高70%（OR 1.7，95%置信区间（CI）1.09 - 2.66，p = 0.02）。
尽管在淋巴结降期方面没有差异，但I-SPY 2试验中的黑人患者接受ALND的可能性显著更高。这些差异可能源于影响手术规划的未测量的患者、医疗服务提供者或系统因素。
