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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2021

01-03-2021 | Breast Cancer | Breast Oncology

Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer

Authors: Olga Kantor, MD, MS, Melia Wakeman, BS, Anna Weiss, MD, Stephanie Wong, MD, Alison Laws, MD, Samantha Grossmith, BA, Elizabeth A. Mittendorf, MD, PhD, Tari A. King, MD

Published in: Annals of Surgical Oncology | Issue 3/2021

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Abstract

Background

Data to guide axillary management after neoadjuvant endocrine therapy (NET) remain limited.

Methods

We analyzed type of axillary surgery [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and residual nodal disease burden after NET in two cohorts of patients with cT1-4N0-1M0 hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer: Dana-Farber/Brigham and Women’s Cancer Center (DFBWCC) cohort (2015–2018) and the National Cancer Data Base (NCDB) cohort (2012–2016). Cox proportional hazard regression was used to determine adjusted 5-year overall survival (OS) by type of axillary surgery.

Results

Ninety-four (4.3%) of 2191 HR+/HER2− DFBWCC patients and 4363 (1.5%) of 283,344 NCDB patients were selected for NET. Of those who underwent axillary surgery, 30 (43.5%) in the DFBWCC cohort and 1583 (40.6%) in the NCDB cohort had ALND. Over 90% of cN0 patients in both cohorts had fewer than three positive nodes on final pathology [44 (95.7%) DFBWCC and 2945 (91.3%) NCDB]. In contrast, only 7 (30.4%) DFBWCC patients and 342 (50.7%) NCDB cN1 patients had fewer than three positive nodes. In the DFBWCC patients, there were no locoregional recurrences and four distant recurrences. In the NCDB, 5-year OS did not differ by type of axillary surgery regardless of residual nodal disease burden: 96.6% SLNB versus 97.9% ALND for 0 positive nodes; 84.4% versus 84.4% for one to two positive nodes, and 75.9% versus 77.3% for three or more positive nodes (all p > 0.10).

Conclusions

In cN0 patients selected for NET, > 90% have fewer than three positive nodes at surgery. The lack of a survival difference between SLNB and ALND suggests an opportunity to de-escalate treatment of the axilla in patients with limited residual nodal disease.
Appendix
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Metadata
Title
Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer
Authors
Olga Kantor, MD, MS
Melia Wakeman, BS
Anna Weiss, MD
Stephanie Wong, MD
Alison Laws, MD
Samantha Grossmith, BA
Elizabeth A. Mittendorf, MD, PhD
Tari A. King, MD
Publication date
01-03-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09073-6

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