Predictors of Nodal Pathological Complete Response in Asian Women with Stage II-III Node-Positive Breast Cancer

Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillar...

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Published inOncology Vol. 99; no. 6; p. 359
Main Authors Montagna, Giacomo, Tong, Yiwei, Ritter, Mathilde, Levi, Jeremy, Weber, Walter P, Chen, Xiaosong, Shen, Kunwei
Format Journal Article
LanguageEnglish
Published Switzerland 01.05.2021
Subjects
Adult
Antineoplastic Agents - therapeutic use
Axilla
Breast Neoplasms - drug therapy
Breast Neoplasms - genetics
Breast Neoplasms - pathology
China - ethnology
Female
Humans
Lymph Node Excision - methods
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Prognosis
Receptor, ErbB-2 - genetics
Retrospective Studies
Treatment Outcome
China
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Summary:Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2- tumors, 38% of HR+/HER2+ tumors, 49% of HR-/HER2+ tumors, and 42% of HR-/HER2-tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2- [referent]: OR 3.42, 95% CI 1.43-8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85-9.50, p = 0.001 for HR-/HER2+; and OR 2.94, 95% CI 1.11-7.74, p = 0.029 for HR-/HER2-), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29-36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09-39.18, p = 0.003). This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.
ISSN:1423-0232
DOI:10.1159/000513454