Clipping the Positive Lymph Node in Patients with Clinically Node Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Impact on Axillary Surgery in the ISPY-2 Clinical Trial.

Autor: Switalla KM; University of Minnesota Medical School, Minneapolis, MN, USA.; Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Boughey JC; Department of Surgery, Mayo Clinic, Rochester, MN, USA., Dimitroff K; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Yau C; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Ladores V; Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Yu H; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Tchou J; Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA., Golshan M; Department of Surgery, Yale School of Medicine, New Haven, CT, USA., Ahrendt G; Department of Surgery, University of Colorado, Aurora, CO, USA., Postlewait LM; Department of Surgery, Emory University, Atlanta, GA, USA., Piltin M; Department of Surgery, Mayo Clinic, Rochester, MN, USA., Reyna CR; Department of Surgery, Loyola University Medical Center, Chicago, IL, USA., Matsen CB; Department of Surgery, University of Utah, Salt Lake City, UT, USA., Tuttle TM; Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Wallace AM; Department of Surgery, University of California San Diego, San Diego, CA, USA., Arciero CA; Department of Surgery, Emory University, Atlanta, GA, USA., Lee MC; Department of Surgery, Moffitt Cancer Center, Tampa, FL, USA., Tseng J; Department of Surgery, City of Hope, Irvine, CA, USA., Son J; Department of Surgery, MedStar Georgetown University, Washington, DC, USA., Rao R; Department of Surgery, Columbia University Medical Center, New York, NY, USA., Sauder C; Department of Surgery, UC Davis Health Comprehensive Cancer Center, Sacramento, CA, USA., Naik A; Department of Surgery, Oregon Health and Science University, Portland, OR, USA., Howard-McNatt M; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA., Lancaster R; Division of Surgical Oncology, The University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Norwood P; Quantum Leap Healthcare Collaborative, San Francisco, CA, USA., Esserman LJ; Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Mukhtar RA; Department of Surgery, University of California San Francisco, San Francisco, CA, USA. rita.mukhtar@ucsf.edu.; UCSF Breast Care Center, San Francisco, CA, USA. rita.mukhtar@ucsf.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Oct; Vol. 31 (11), pp. 7249-7259. Date of Electronic Publication: 2024 Jul 12.
DOI: 10.1245/s10434-024-15792-x
Abstrakt: Background: For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain.
Patients and Methods: We retrospectively analyzed cN+ ISPY-2 patients (2011-2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.
Results: Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8-6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4-1.7, p = 0.7; HR 1.8, 95% CI 0.5-6.0, p = 0.3, respectively].
Conclusion: Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.
(© 2024. The Author(s).)
Databáze: MEDLINE
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