A PREDICTIVE MODEL FOR AXILLARY LYMPH NODE PATHOLOGIC COMPLETE RESPONSE IN PREMENOPAUSAL BREAST CANCER PATIENTS AFTER NEOADJUVANT CHEMOTHERAPY
A CROSS-SECTIONAL STUDY IN A L ATIN-AMERICAN POPULATION
Keywords:
Breast neoplasm, sentinel lymph node, neoadjuvant therapy, nomogramsAbstract
Introduction: A large group of lymph node-positive breast cancer patients receive neoadjuvant chemotherapy and subsequently undergo axillary lymph node dissection. It has been previously proposed that axillary lymph node dissection may be avoided — and it’s associated reduced morbidity — in patients showing pathologic complete response. Therefore, the purpose of this study was to develop a nomogram to predict axillary node pathologic response to neoadjuvant chemotherapy in breast cancer patients in order to guide the surgical treatment decision-making process for this group of patients. Methods: A cross-sectional, secondary data study was carried out between 2013-2016 on 222 lymph node-positive breast cancer patients who received neoadjuvant chemotherapy followed by locoregional management, including axillary lymph node dissection. Logistic regression analysis was performed to determine the association of the axillary pathologic complete response with the different clinical and pathological variables. Variables found to be statistically significantly associated with axillary pCR (pathologic complete response) were used to create the logistic regression model and the nomogram in pre-menopausal patients. Axillary pCR was defined as absence of residual disease in the breast and of micro-metastasis in axillary lymph nodes. Samples with isolated tumor cells were considered as positive for residual disease. Results: a total of 222 patients were included, of which 131 were premenopausal at the time of diagnosis. Axillary pathologic complete response was observed in 55.7% (73 of 131) of patients, and was significantly associated with estrogen receptor (ER) negative tumors (OR 2.59, 95%CI 1.21-5.53), progesterone receptor (PR) negative tumors (OR 2.63, 95%CI 1.28-5.38), and Her2 positive tumors (OR 0.40, 95%CI 0.19-0.84), for which a significant correlation with increased probability of achieving axillary pathologic complete response was evidenced. Conclusion: The performance of this model to predict axillary pCR in pre-menopausal patients was weak, and therefore the decision to avoid surgical axillary dissection should not be based solely on the developed nomogram. However, further studies may lead to validation of this model.
Downloads
References
Hennessy BT, Hortobagyi GN, Rouzier R, Kuerer H, Sneige
N, Buzdar AU, et al. Outcome after pathologic complete
eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin
Oncol Off J Am Soc Clin Oncol. 2005;23(36):9304-11. https://doi.org/10.1200/JCO.2005.02.5023
von Minckwitz G, Untch M, Blohmer J-U, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of
pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(15):1796-804. https://doi.org/10.1200/JCO.2011.38.8595
Koolen BB, Valdés Olmos RA, Wesseling J, Vogel WV, Vincent AD, Gilhuijs KGA, et al. Early assessment of axillary response with 18F-FDG PET/CT during neoadjuvant chemotherapy in stage II-III breast cancer: implications for surgical management of the axilla. Ann Surg Oncol. 2013;20(7):2227-35. https://doi.org/10.1245/s10434-013-2902-0
Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after
neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-61. https://doi.org/10.1001/ jama.2013.278932
Yagata H, Yamauchi H, Tsugawa K, Hayashi N, Yoshida A, Kajiura Y, et al. Sentinel node biopsy after neoadjuvant
chemotherapy in cytologically proven node-positive breast cancer. Clin Breast Cancer. 2013;13(6):471-7. https://doi.org/10.1016/j.clbc.2013.08.014
Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(16):3676-85. https://doi.org/10.1200/JCO.2005.07.032
Alvarado R, Yi M, Le-Petross H, Gilcrease M, Mittendorf EA, Bedrosian I, et al. The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer. Ann Surg Oncol. 2012;19(10):3177-84. https://doi.org/10.1245/s10434-012-2484-2
Donegan WL. Prognostic factors. Stage and receptor status in breast cancer. Cancer. 1992;70(6 Suppl.):1755-64.
Ververs JM, Roumen RM, Vingerhoets AJ, Vreugdenhil G, Coebergh JW, Crommelin MA, et al. Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer. Eur J Cancer. 2001;37(8):991-9.
Del Bianco P, Zavagno G, Burelli P, Scalco G, Barutta L, Carraro P, et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2008;34(5):508-13. https://doi.org/10.1016/j.ejso.2007.05.017
Assi H, Sbaity E, Abdelsalam M, Shamseddine A. Controversial indications for sentinel lymph node biopsy in breast cancer patients. BioMed Res Int. 2015;2015:405949. https://doi.org/10.1155/2015/405949
Straver ME, Rutgers EJT, Russell NS, Oldenburg HSA, Rodenhuis S, Wesseling J, et al. Towards rational axillary treatment in relation to neoadjuvant therapy in breast cancer. Eur J Cancer. 2009;45(13):2284-92. https://doi.org/10.1016/j.ejca.2009.04.029
Pecha V, Kolarik D, Kozevnikova R, Hovorkova K, Hrabetova P, Halaska M, et al. Sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Cancer. 2011;117(20):4606-16. https://doi.org/10.1002/cncr.26102
Schipper R-J, Moossdorff M, Nelemans PJ, Nieuwenhuijzen GAP, de Vries B, Strobbe LJA, et al. A model to predict pathologic complete response of axillary lymph nodes to neoadjuvant chemo(immuno)therapy in patients with clinically nodepositive breast cancer. Clin Breast Cancer. 2014;14(5):315-22. https://doi.org/10.1016/j.clbc.2013.12.015
Jin X, Jiang Y-Z, Chen S, Shao Z-M, Di G-H. A Nomogram for Predicting the Pathological Response of Axillary Lymph Node Metastasis in Breast Cancer Patients. Sci Rep. 2016;6:32585. https://dx.doi.org/10.1038%2Fsrep32585
Kim JY, Park HS, Kim S, Ryu J, Park S, Kim SI. Prognostic Nomogram for Prediction of Axillary Pathologic Complete Response After Neoadjuvant Chemotherapy in Cytologically Proven Node-Positive Breast Cancer. Medicine (Baltimore). 2015;94(43):e1720. https://doi.org/10.1097/MD.0000000000001720
Vila J, Mittendorf EA, Farante G, Bassett RL, Veronesi P, Galimberti V, et al. Nomograms for Predicting Axillary
Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Patients with Breast Cancer. Ann Surg Oncol.
;23(11):3501-9. https://doi.org/10.1245/s10434-016-5277-118. Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98(19):10869-74. https://doi.org/10.1073/pnas.191367098
Mattes MD, Bhatia JK, Metzger D, Ashamalla H, Katsoulakis E. Breast Cancer Subtype as a Predictor of Lymph Node Metastasis according to the SEER Registry. J Breast Cancer. 2015;18(2):143-8. https://dx.doi.org/10.4048%2Fjbc.2015.18.2.143
Weigelt B, Baehner FL, Reis-Filho JS. The contribution of gene expression profiling to breast cancer classification,
prognostication and prediction: a retrospective of the last decade. J Pathol. 2010;220(2):263-80. https://doi.org/10.1002/path.2648
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 Carolina Benavides Duque, Luis Fernando Zapata Pérez, Ana María Fidalgo Zapata, Laura López, Elsa Vásquez, Javier Cuello López
This work is licensed under a Creative Commons Attribution 4.0 International License.
