Universität zu Köln

Gerber, Bernd, Schneeweiss, Andreas, Moebus, Volker, Golatta, Michael ORCID: 0000-0002-2605-0060, Tesch, Hans, Krug, David ORCID: 0000-0001-8811-5416, Hanusch, Claus, Denkert, Carsten, Luebbe, Kristina, Heil, Joerg, Huober, Jens, Ataseven, Beyhan ORCID: 0000-0002-2823-7590, Klare, Peter, Hahn, Markus, Untch, Michael, Kast, Karin, Jackisch, Christian, Thomalla, Joerg, Seither, Fenja, Blohmer, Jens-Uwe ORCID: 0000-0002-7969-250X, Rhiem, Kerstin, Fasching, Peter A., Nekljudova, Valentina, Loibl, Sibylle and Kuehn, Thorsten ORCID: 0000-0002-8708-2824 (2022). 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, 14 (3). BASEL: MDPI. ISSN 2072-6694

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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. 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gerber, Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneeweiss, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Moebus, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Golatta, Michael UNSPECIFIED orcid.org/0000-0002-2605-0060 UNSPECIFIED Tesch, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Krug, David UNSPECIFIED orcid.org/0000-0001-8811-5416 UNSPECIFIED Hanusch, Claus UNSPECIFIED UNSPECIFIED UNSPECIFIED Denkert, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Luebbe, Kristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Heil, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Huober, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Ataseven, Beyhan UNSPECIFIED orcid.org/0000-0002-2823-7590 UNSPECIFIED Klare, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hahn, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Untch, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Kast, Karin UNSPECIFIED UNSPECIFIED UNSPECIFIED Jackisch, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomalla, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Seither, Fenja UNSPECIFIED UNSPECIFIED UNSPECIFIED Blohmer, Jens-Uwe UNSPECIFIED orcid.org/0000-0002-7969-250X UNSPECIFIED Rhiem, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Fasching, Peter A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nekljudova, Valentina UNSPECIFIED UNSPECIFIED UNSPECIFIED Loibl, Sibylle UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuehn, Thorsten UNSPECIFIED orcid.org/0000-0002-8708-2824 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-696644
DOI:	10.3390/cancers14030521
Journal or Publication Title:	Cancers
Volume:	14
Number:	3
Date:	2022
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2072-6694
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AMERICAN-COLLEGE; CHEMOTHERAPY; ULTRASOUND; BIOPSY; RISK; METAANALYSIS; SENTINA; THERAPY; SURGERY; IMPACT Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69664