Annals of surgical oncology 2019 Jun 21
Prognostic Significance of Residual Axillary Nodal Micrometastases and Isolated Tumor Cells After Neoadjuvant Chemotherapy for Breast Cancer.
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.
Related Questions
How do your PMRT recommendations change with ITCs after neoadjuvant chemotherapy if they had SLNB only versus ALND in light of B51?
Data such as from Dana-Farber/Brigham and Women’s Cancer Center and the National Cancer Database (Wong et al., PMID 31228134), as well as the OPBC-05/ICARO study (Montagna et al., PMID 39509672), indicate that patients with isolated tumor cells in axillary nodes after neoadjuvant chemotherapy (ypN0i...
Do you consider post-NAC isolated tumor cells in LNs to be residual disease in TNBC to justify capecitabine?
The brief answer is yes, I would. These patients were included in the CREATE-X trial (Masuda et al., PMID 28564564). Also, there is data out of Boston that following neoadjuvant chemotherapy, patients with even isolated tumor cells in lymph nodes have a poorer prognosis (Wong et al., PMID 31228134)....