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01-10-2019 | Breast Cancer | Breast Oncology

Prognostic Significance of Residual Axillary Nodal Micrometastases and Isolated Tumor Cells After Neoadjuvant Chemotherapy for Breast Cancer

Authors: Stephanie M. Wong, MD, MPH, Nora Almana, MD, Jungeun Choi, MD, Jiani Hu, MPH, Haley Gagnon, MD, Kelsey Natsuhara, MD, Abra H. Shen, SB, Stephen DeSantis, BSc, Laura Dominici, MD, Mehra Golshan, MD, Anna Weiss, MD, Jennifer Bellon, MD, Elizabeth A. Mittendorf, MD, PhD, Tari A. King, MD

Published in: Annals of Surgical Oncology | Issue 11/2019

Abstract

Background

The prognostic significance of low-volume residual nodal disease following neoadjuvant chemotherapy (NAC) is unknown.

Methods

Women with cT1–4N0–1 breast cancer treated with NAC were identified from Dana-Farber/Brigham and Women’s Cancer Center (DFBWCC) and the National Cancer Database (NCDB). Disease-free survival (DFS) and overall survival (OS) estimates according to pathologic nodal status were calculated using the Kaplan–Meier method, with Cox proportional hazards regression used to assess the effect of clinical variables on survival outcomes.

Results

Among 967 DFBWCC patients, 27 (2.8%) had residual isolated tumor cells (ITCs) and 61 (6.3%) had micrometastases. Five-year DFS was significantly worse in those with residual ITCs (73.5%) and micrometastases (74.7%) relative to those who were ypN0 following NAC (88.4%, p < 0.001). On adjusted analysis, those with residual ITCs (hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.20–3.81) and micrometastases (HR 2.14, 95% CI 1.20–3.81) had increased risk of recurrence relative to ypN0 patients. Among 35,536 NCDB patients, 543 (1.5%) had ITCs and 1132 (3.2%) had micrometastases. Five-year OS estimates were significantly worse with increasing residual nodal burden: ypN0, 88.9%; ypN0[i+], 82.8%; ypN1mi, 79.5%; ypN1, 77.6% (p < 0.001). Compared with patients with ypN0 disease, NCDB patients with ITCs and micrometastases had 1.9- and 2.2-fold risk of death (p < 0.001). On subgroup analysis, the effect of low-volume residual disease on mortality was most pronounced in patients with triple-negative and human epidermal growth factor receptor 2 (HER2)-positive disease.

Conclusions

Low-volume residual nodal disease following NAC is associated with poorer DFS and OS relative to those who are node negative.

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Title: Prognostic Significance of Residual Axillary Nodal Micrometastases and Isolated Tumor Cells After Neoadjuvant Chemotherapy for Breast Cancer
Authors: Stephanie M. Wong, MD, MPH
Nora Almana, MD
Jungeun Choi, MD
Jiani Hu, MPH
Haley Gagnon, MD
Kelsey Natsuhara, MD
Abra H. Shen, SB
Stephen DeSantis, BSc
Laura Dominici, MD
Mehra Golshan, MD
Anna Weiss, MD
Jennifer Bellon, MD
Elizabeth A. Mittendorf, MD, PhD
Tari A. King, MD
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 11/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-019-07517-2

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Prognostic Significance of Residual Axillary Nodal Micrometastases and Isolated Tumor Cells After Neoadjuvant Chemotherapy for Breast Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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