Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study |
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| Affiliation: | 1. Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery, Istanbul, Turkey;2. Istanbul University, Institute of Oncology, Surgical Oncology Division, Istanbul, Turkey;3. American Hospital, Istanbul, Turkey;4. Zonguldak Bülent Ecevit University, Department of General Surgery, Zonguldak, Turkey;5. İstanbul Samatya Training and Research Hospital, Department of General Surgery, Istanbul, Turkey;6. Vakıf Guraba Bezmialem Valide Sultan University, Department of General Surgery, Istanbul, Turkey;7. Acıbadem University, Department of General Surgery, Istanbul, Turkey;8. The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Department of General Surgery, Izmir, Turkey;9. Samsun 19 Mayıs University, Faculty of Medicine, Department of General Surgery, Samsun, Turkey;10. Ege University, Faculty of Medicine, Department of General Surgery, Izmir, Turkey;11. Özel Başarı Hospital, Department of Surgery, Istanbul, Turkey;12. Istanbul University, Institute of Oncology, Department of Radiation Oncology, Istanbul, Turkey;13. Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey;1. Department of Surgery, McMaster University, Hamilton, ON, Canada;2. Department of Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada;3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada;4. Biostatistics Unit, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada;1. Interdisciplinary Breast Centre, Department of Gynaecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany;2. Department of Gynaecology and Obstetrics, Klinikum Landshut, Landshut, Germany;3. Department of Gynaecology and Obstetrics, University of Düsseldorf, Düsseldorf, Germany;4. Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany;5. Department of Gynaecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany;6. Spital Rheinfelden, Rheinfelden, Switzerland;7. Department of Gynaecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany;8. Department of Pathology, University Medical Centre Tübingen, Tübingen, Germany;9. Department of Pathology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany;10. Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany;11. German Breast Group, Neu Isenburg, Germany;12. University Women''s Hospital Frankfurt, Frankfurt, Germany;13. Elisabeth-Krankenhaus Kassel gGmbH, Kassel, Germany;14. Breast Cancer Center, General Hospital Linz, Linz, Austria;1. Laboratory of Molecular Diagnosis of Cancer & Breast Medical Oncology, Clinical Research Center for Breast,West China Hospital, Sichuan University, Chengdu, China;2. Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China |
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| Abstract: | PurposeFactors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC).MethodsBetween 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation.ResultsMedian age was 46 (23–70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 patients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24–172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14–5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16–5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89–5.01) were found to have an increased HR compared to others in 5-year DFS. However, no difference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44–3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63–5.79).ConclusionALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy is provided. |
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| Keywords: | Sentinel lymph node biopsy Neoadjuvant chemotherapy Local recurrence Pathologic complete response Isolated tumor cells Micrometastasis |
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