TY - JOUR
T1 - Does Neoadjuvant Chemotherapy in Clinical T1–T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?
AU - Cortina, Chandler S.
AU - Lloren, Jan Irene
AU - Rogers, Christine
AU - Johnson, Morgan K.
AU - Cobb, Adrienne N.
AU - Huang, Chiang Ching
AU - Kong, Amanda L.
AU - Singh, Puneet
AU - Teshome, Mediget
N1 - Publisher Copyright:
© Society of Surgical Oncology 2024.
PY - 2024
Y1 - 2024
N2 - Background: Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1–2N0 TNBC. Methods: The National Cancer Database (NCDB) was queried for women with operable cT1–2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND. Results: Overall, 55,624 women were included: 26.9% (n = 14,942) underwent NAC and 73.1% (n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p < 0.001) with more cT2 tumors (71.6% vs. 31.0%; p < 0.001), and had lower ALND rates (4.3% vs. 5.5%; p < 0.001). The upfront surgery cohort was more likely to have one to three pathologically positive nodes (12.1% vs. 6.5%; odds ratio [OR] 2.37, 95% confidence interval (CI) 2.17–2.58; p < 0.001) but there was no difference in the likelihood of ALND (OR 1.1, 95% CI 0.99–1.24; p = 0.08). Conclusion: Patients who underwent upfront surgery were more likely to be pN+; however, ALND rates were similar between the two cohorts. Thus, the use of NAC does not result in a higher odds of ALND and the decision for NAC should be individualized and based on modern guidelines and systemic therapy benefits.
AB - Background: Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1–2N0 TNBC. Methods: The National Cancer Database (NCDB) was queried for women with operable cT1–2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND. Results: Overall, 55,624 women were included: 26.9% (n = 14,942) underwent NAC and 73.1% (n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p < 0.001) with more cT2 tumors (71.6% vs. 31.0%; p < 0.001), and had lower ALND rates (4.3% vs. 5.5%; p < 0.001). The upfront surgery cohort was more likely to have one to three pathologically positive nodes (12.1% vs. 6.5%; odds ratio [OR] 2.37, 95% confidence interval (CI) 2.17–2.58; p < 0.001) but there was no difference in the likelihood of ALND (OR 1.1, 95% CI 0.99–1.24; p = 0.08). Conclusion: Patients who underwent upfront surgery were more likely to be pN+; however, ALND rates were similar between the two cohorts. Thus, the use of NAC does not result in a higher odds of ALND and the decision for NAC should be individualized and based on modern guidelines and systemic therapy benefits.
UR - http://www.scopus.com/inward/record.url?scp=85183006469&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183006469&partnerID=8YFLogxK
U2 - 10.1245/s10434-024-14914-9
DO - 10.1245/s10434-024-14914-9
M3 - Article
C2 - 38270828
AN - SCOPUS:85183006469
SN - 1068-9265
VL - 31
SP - 3128
EP - 3140
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -