Internal Mammary Lymphadenopathy Does Not Impact Oncologic Outcomes in Patients Treated with Neoadjuvant Chemotherapy: Results from the I-SPY2 Clinical Trial.

Autor: Piltin MA; Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA. Piltin.mara@mayo.edu., Norwood P; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Ladores V; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Mukhtar RA; Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Sauder CA; Department of Surgery, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA., Golshan M; Department of Surgery, Yale Medicine, New Haven, CT, USA., Tchou J; Division of Breast Surgery, Penn Medicine at University of Pennsylvania, Philadelphia, PA, USA., Rao R; Division of Breast Surgery, Columbia University Medical Center, New York, NY, USA., Lee MC; Moffitt Cancer Center Comprehensive Breast Program, Tampa, FL, USA., Son J; Breast Surgical Oncology, MedStar Georgetown University Hospital, Washington, DC, USA., Reyna C; Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Mayowood, IL, USA., Hewitt K; Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashvilee, TN, USA., Kuerer H; Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA., Ahrendt G; Breast Surgical Oncology, UC Health, Highlands Ranch, CO, USA., Greenwalt I; Breast Surgical Oncology, MedStar Georgetown University Hospital, Washington, DC, USA., Tseng J; Department of Surgery, City of Hope Orange County, Irvine, CA, USA., Postlewait L; Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA., Howard-McNatt M; Department of Surgical Oncology, Wake Forest, Winston-Salem, NC, USA., Jaskowiak N; Department of Surgery, University of Chicago, Chicago, IL, USA., Esserman LJ; Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Boughey JC; Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Oct; Vol. 31 (11), pp. 7420-7428. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1245/s10434-024-15708-9
Abstrakt: Background: Internal mammary lymphadenopathy (IML) plays a role in breast cancer stage and prognosis. We aimed to evaluate method of IML detection, how IML impacts response to neoadjuvant chemotherapy (NAC), and oncologic outcomes.
Methods: We evaluated patients enrolled in the I-SPY-2 clinical trial from 2010 to 2022. We captured the radiographic method of IML detection (magnetic resonance imaging [MRI], positron emission tomography/computed tomography [PET/CT], or both) and compared patients with IML with those without. Rates of locoregional recurrence (LRR), distant recurrence (DR) and event-free survival (EFS) were compared by bivariate analysis.
Results: Of 2095 patients, 198 (9.5%) had IML reported on pretreatment imaging. The method of IML detection was 154 (77.8%) MRI only, 11 (5.6%) PET/CT only, and 33 (16.7%) both. Factors associated with IML were younger age (p = 0.001), larger tumors (p < 0.001), and higher tumor grade (p = 0.027). Pathologic complete response (pCR) was slightly higher in the IML group (41.4% vs. 34.0%; p = 0.03). There was no difference in breast or axillary surgery (p = 0.41 and p = 0.16), however IML patients were more likely to undergo radiation (68.2% vs. 54.1%; p < 0.001). With a median follow up of 3.72 years (range 0.4-10.2), there was no difference between IM+ versus IM- in LRR (5.6% vs. 3.8%; p = 0.25), DR (9.1% vs. 7.9%; p = 0.58), or EFS (61.6% vs. 57.2%; p = 0.48). This was true for patients with and without pCR.
Conclusions: In this large cohort of patients treated with NAC, outcomes were not negatively impacted by IML. We demonstrated that IML influences treatment selection but is not a poor prognostic indicator when treated with modern NAC and multidisciplinary disease management.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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