A new era of neoadjuvant treatment with Pertuzumab: Should the 10‐lymph node guideline for axillary lymph node dissection in breast cancer be revised?

O’Leary, Michael P.; Beckord, Brian; Mock, Kyle; Venegas, Rose; Yeh, James; Dauphine, Christine; Ozao‐Choy, Junko

doi:10.1002/cnr2.1132

Cited by 2 publications

(1 citation statement)

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“…With the development of chemotherapy regimens and targeted anti-HER2 treatment, the primary tumor and axillary pCR rates have increased substantially. A previous study found that fewer than 10 lymph nodes were found in 41.7% of 139 breast cancer patients who underwent axillary dissection and received neoadjuvant pertuzumab, however in patients who received neoadjuvant chemotherapy but did not receive pertuzumab, only 18.6% of patients had less than 10 axillary lymph nodes dissected ( 37 ). Therefore, the low lymph node yield will underestimate the number of metastatic lymph nodes and may lead to improper prediction of prognosis and improper treatment.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Liu

Zhang

et al. 2022

Front. Surg.

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BackgroundAs neoadjuvant chemotherapy is widely used in breast cancer patients, the lymph node ratio has not been fully validated as a prognostic indicator of breast cancer received neoadjuvant chemotherapy. This study was conducted to investigate the prognostic value of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy.MethodsSystematic searches were performed in the PubMed, Embase, and Cochrane Library databases until 15 December 2021 for studies on the association between lymph node ratio and the prognosis of breast cancer after neoadjuvant chemotherapy. Overall survival and disease-free survival were used as outcome events, and hazard ratio was chosen as the parameter to evaluate the correlation. The dose-response relationship was assessed by restricted cubic splines. In the subgroup analyses, which were used to explore potential heterogeneity among the included studies according to study region and sample size. Sensitivity analysis was performed to assess the stability of individual studies, and publication bias was determined with funnel plots, Begg’s test, and Egger&apos;s test. All statistical analyses were performed using Stata 15.1.ResultsA total of 12 studies with 4,864 patients were included in this meta-analysis. In this study, high lymph node ratio was significantly associated with decreased overall survival (HR: 4.74; 95%CI: 3.36–6.67; P < 0.001) and disease-free survival (HR: 4.77; 95%CI: 3.69–6.17; P < 0.001). Moreover, the dose-response meta-analysis showed a linear association between higher lymph node ratio and shorter overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy.ConclusionsThe meta-analysis suggested that high lymph node ratio was significantly associated with short overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy. Therefore, lymph node ratio is an independent predictive factor for the prognosis of breast cancer patients after neoadjuvant chemotherapy, which may better refine the cancer staging system.

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Section: Discussionmentioning

confidence: 99%

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Liu

Zhang

et al. 2022

Front. Surg.

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Lower lymph node yield in axillary lymph node dissection specimens in breast cancer patients receiving neoadjuvant chemotherapy: Quality concern or treatment effect?

2021

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Axillary lymph node dissection (ALND) specimens should have at least ten‐lymph nodes for examination according to established guidelines. Nonetheless, recent evidence suggests that neoadjuvant chemotherapy (NAC) results in fewer nodes in the specimen. We sought to examine if NAC patients have lower lymph node yield from ALND specimens and whether the number of lymph nodes in the specimen is correlated with pathologic complete response (pCR). Using the National Cancer Database (NCDB), a study cohort of female patients with node‐positive, non‐metastatic invasive breast cancer diagnosed from 2012 to 2015 was identified. The axillary lymph node retrieval count was compared in NAC and non‐NAC patients and then correlated with pCR. A multivariable analysis was performed to identify factors that were associated with less than ten‐lymph nodes in the ALND pathologic specimen. Of 56,976 patients identified, 27,197 (48%) received neoadjuvant chemotherapy; 29,779 (52%) did not. NAC patients failed to meet the ten‐lymph node minimum in the ALND specimen more often than non‐NAC patients (35% vs. 27%, p < 0.001). NAC patients with fewer than ten‐lymph nodes were more likely to have a pCR than those with ten or more (22% vs. 16%, p < 0.001). On multivariable analysis, pCR of the primary tumor and receptor status were found to be independent predictors of having fewer than ten‐lymph nodes in the ALND specimen. Node‐positive breast cancer patients that underwent NAC were more likely to not meet the ten‐lymph node standard. However, NAC patients who did not meet the minimum were also more likely to have a pCR compared to NAC patients who did. This suggests lower lymph node yield may not truly be a marker of lower quality surgery but rather a potential marker of NAC treatment effect.

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A new era of neoadjuvant treatment with Pertuzumab: Should the 10‐lymph node guideline for axillary lymph node dissection in breast cancer be revised?

Cited by 2 publications

References 10 publications

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Lower lymph node yield in axillary lymph node dissection specimens in breast cancer patients receiving neoadjuvant chemotherapy: Quality concern or treatment effect?

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