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

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 n...

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Veröffentlicht in:Cancers 2022-01, Vol.14 (3), p.521
Hauptverfasser: Gerber, Bernd, Schneeweiss, Andreas, Möbus, Volker, Golatta, Michael, Tesch, Hans, Krug, David, Hanusch, Claus, Denkert, Carsten, Lübbe, Kristina, Heil, Jörg, Huober, Jens, Ataseven, Beyhan, Klare, Peter, Hahn, Markus, Untch, Michael, Kast, Karin, Jackisch, Christian, Thomalla, Jörg, Seither, Fenja, Blohmer, Jens-Uwe, Rhiem, Kerstin, Fasching, Peter A, Nekljudova, Valentina, Loibl, Sibylle, Kühn, Thorsten
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Sprache:eng
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Zusammenfassung: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). Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial. 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; = 0.0028 for iDFS) was the strongest independent prognostic factor. 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.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers14030521