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Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Hanusch C, Denkert C, Lübbe K, Heil J, Huober J, Ataseven B, Klare P, Hahn M, Untch M, Kast K, Jackisch C, Thomalla J, Seither F, Blohmer JU, Rhiem K, Fasching PA, Nekljudova V, Loibl S, Kühn T. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers (Basel) 2022; 14:cancers14030521. [PMID: 35158789 PMCID: PMC8833390 DOI: 10.3390/cancers14030521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The extent of axillary surgery has been reduced in recent years to minimize side effects. However, a negative impact of reduced surgery on outcome must be avoided. We investigated for whom the extent of surgery can be safely reduced by examining early-stage breast cancer patients converting from lymph node (LN)-positive to LN-negative disease after neoadjuvant systemic treatment (NAST). Of 242 initially LN-positive patients treated within the GeparOcto trial, 54.5% were classified as LN-negative after NAST, 31.8% as LN-positive, and for 13.6% data were missing. Overall, 92.1% of patients underwent complete axillary LN dissection, with 6.6% undergoing sentinel LN dissection only. At surgery, 55.4% of patients had no signs of cancer in the LN, 45.0% had no signs of cancer in the breast (of those 8.3% had involved LN), and 41.3% had no signs of cancer at all. Patients with involved LN still had a bad prognosis. Conversion from LN-positive to LN-negative after NAST is of highest prognostic value. Surgical axillary staging after NAST is essential in these patients to offer tailored treatment. Abstract Background: The conversion of initially histologically confirmed axillary lymph node-positive (pN+) to ypN0 after neoadjuvant systemic treatment (NAST) is an important prognostic factor in breast cancer (BC) patients and may influence surgical de-escalation strategies. We aimed to determine pCR rates in lymph nodes (pCR-LN), the breast (pCR-B), and both (tpCR) in women who present with pN+ BC, to assess predictors for response and the impact of pCR-LN, pCR-B, and tpCR on invasive disease-free survival (iDFS). Methods: Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial. Results: Of 242 patients with initially pN+ disease, 134 (55.4%) had a pCR-LN, and 109 (45.0%) a pCR-B. Of the 109 pCR-B patients, 9 (8.3%) patients had involved LN, and 100 (41.3%) patients had tpCR. Those with involved LN still had a bad prognosis. As expected, pCR-B and intrinsic subtypes (TNBC and HER2+) were identified as independent predictors of pCR-LN. pCR-LN (ypN0; hazard ratio 0.42; 95%, CI 0.23–0.75; p = 0.0028 for iDFS) was the strongest independent prognostic factor. Conclusions: In initially pN+ patients undergoing NAST, the conversion to ypN0 is of high prognostic value. Surgical axillary staging after NAST is still essential in these patients to offer tailored treatment.
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Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany;
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany;
| | - Volker Möbus
- Medical Clinic II, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; (M.G.); (J.H.)
| | - Hans Tesch
- Oncology Practice, Bethanien Hospital Frankfurt, Im Prüfling 17-19, 60389 Frankfurt, Germany;
| | - David Krug
- Department of Radiotherapy, University Hospital Schleswig Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany;
| | - Claus Hanusch
- Department of Senology, Rotkreuz-Klinikum, Rotkreuzplatz 8, 80634 Munich, Germany;
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Kristina Lübbe
- Breast Center, Diakovere Henriettenstift, Schwemannstraße 17, 30559 Hannover, Germany;
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; (M.G.); (J.H.)
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Beyhan Ataseven
- Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany;
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistraße 92, 45136 Essen, Germany
| | - Peter Klare
- Oncologic Medical Care Center Krebsheilkunde, Möllendorffstraße 52, 10367 Berlin, Germany;
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, Calwerstraße 7, 72076 Tuebingen, Germany;
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany;
| | - Karin Kast
- Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069 Offenbach, Germany;
| | - Jörg Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Neversstraße 5, 56068 Koblenz, Germany;
| | - Fenja Seither
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center Charité, Charitéplatz 1, 10117 Berlin, Germany;
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University of Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany;
| | - Valentina Nekljudova
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
| | - Sibylle Loibl
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
- Correspondence: ; Tel.: +49-610-2748-0411; Fax: +49-610-2748-0111
| | - Thorsten Kühn
- Department of Gynecology, Klinikum Esslingen, Hirschlandstraße 97, 73730 Esslingen, Germany;
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Díaz-Casas SE, Castilla-Tarra JA, Pena-Torres E, Orozco-Ospino M, Mendoza-Diaz S, Nuñez-Lemus M, Garcia-Angulo O, Garcia-Mora M, Guzman-AbiSaab L, Lehmann-Mosquera C, Angel-Aristizabal J, Duarte-Torres C, Vergel-Martinez JC. Pathological Response to Neoadjuvant Chemotherapy and the Molecular Classification of Locally Advanced Breast Cancer in a Latin American Cohort. Oncologist 2019; 24:e1360-e1370. [PMID: 31346133 PMCID: PMC6975950 DOI: 10.1634/theoncologist.2019-0300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/27/2019] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The majority of patients with breast cancer in Colombia are admitted into oncological centers at locally advanced stages of the disease (53.9%). The aim of this study was to describe the pathological response obtained with neoadjuvant chemotherapy (NACT) according to the molecular classification of breast cancer in patients with locally advanced tumors treated within the National Cancer Institute (NCI) Functional Breast Cancer Unit (FBCU) in Bogotá, Colombia. MATERIALS AND METHODS This was an observational, descriptive, historical cohort study of patients with locally advanced breast cancer treated within the NCI FBCU. RESULTS We included 414 patients who received NACT and surgical management. Most patients had luminal B HER2-negative tumors (n = 134, 32.4%). The overall rate of pathological complete response (pCR) ypT0/ypN0 was 15.2% (n = 63). Tumors that presented the highest rate of pCR were pure HER2, at 40.5% (n = 15; odds ratio [OR], 6.7); however, with a follow-up of 60 months, only the triple negative tumors presented a statistically significant difference for event-free survival (EFS; median recurrence time, 18 months; range, 1-46) and overall survival (OS; median follow-up, 31 months; range 10-57). The molecular subtype that most recurrences presented was luminal B HER2 negative, at 38.3% (n = 28). The majority of recurrences (93.2 %; n = 68; OR, 5.9) occurred in patients in whom no pathological response was obtained (Chevallier 3 and 4). CONCLUSION Pathological response in locally advanced tumors is related to the molecular subtype of breast cancer, finding higher pCR rates in pure HER2 and triple-negative tumors. A direct relationship was found between disease recurrences and the pathological response, evidencing greater tumor recurrence in patients who did not respond to NACT (Chevallier 3 and 4). EFS and OS were greater in patients with pCR, with statistical significance only in triple-negative tumors. IMPLICATIONS FOR PRACTICE This research article is of scientific interest, because it describes the clinical and pathological features and analyzes the correlation between pathological response to neoadjuvant chemotherapy and the molecular classification of locally advanced breast cancer in patients treated in the National Cancer Institute in Bogotá, Colombia. It was found that pathological response is related to the molecular subtype of breast cancer. In addition, there is a direct relationship between disease recurrences and pathological response. The survival results were greater in patients with pathological complete response.
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Affiliation(s)
| | | | - Esperanza Pena-Torres
- Office of the Deputy Director for Research, Epidemiological Surveillance, Promotion and Prevention, National Cancer Institute, Bogotá, D.C., Colombia
| | - Martha Orozco-Ospino
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
| | - Sara Mendoza-Diaz
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
| | - Marcela Nuñez-Lemus
- Office of the Deputy Director for Research, Epidemiological Surveillance, Promotion and Prevention, National Cancer Institute, Bogotá, D.C., Colombia
| | - Oscar Garcia-Angulo
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
| | - Mauricio Garcia-Mora
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
| | - Luis Guzman-AbiSaab
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
| | | | | | - Carlos Duarte-Torres
- Breast and Soft Tissue Clinic, National Cancer Institute, Bogotá, D.C., Colombia
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