Nomograms for Predicting Axillary Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Patients with Breast Cancer

Vila, José; Mittendorf, Elizabeth A.; Farante, G.; Bassett, Roland L.; Veronesi, Giulia; Galimberti, Viviana; Peradze, Nicolas; Stauder, Michael C.; Chávez-MacGregor, Mariana; Litton, Jennifer; Huo, Lei; Kuerer, Henry Mark; Hunt, Kelly K.; Caudle, Abigail S.

doi:10.1245/s10434-016-5277-1

Cited by 66 publications

(55 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, additional tools may prove helpful in estimating axillary nodal response to NAC in patients with clinical node-positive breast cancer, and in identifying which patients who do not require ALND. Models have been designed to predict the probabilities or risks of clinical outcomes, thereby assisting clinicians and patients in determining how to manage breast cancer [ 14 15 ]. These models have limitations, however, because they did not evaluate tumor response after NAC, but because they were not validated using data from an institution not involved in model development.…”

Section: Introductionmentioning

confidence: 99%

Improved Model for Predicting Axillary Response to Neoadjuvant Chemotherapy in Patients with Clinically Node-Positive Breast Cancer

et al. 2017

View full text Add to dashboard Cite

PurposePathological complete response (pCR) of axillary lymph node (LN) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC). Treatment of the axilla after NAC is not well established and the value of sentinel LN biopsy following NAC remains unclear. This study investigated the predictive value of axillary response following NAC and evaluated the predictive value of a model based on axillary response.MethodsData prospectively collected on 201 patients with clinically node-positive breast cancer who were treated with NAC and underwent axillary LN dissection (ALND) were retrieved. A model predictive of axillary pCR was developed based on clinicopathologic variables. The overall predictive ability between models was compared by receiver operating characteristic (ROC) curve analysis.ResultsOf 201 patients who underwent ALND after NAC, 68 (33.8%) achieved axillary pCR. Multivariate analysis using axillary LN pCR after NAC as the dependent variable showed that higher histologic grade (p=0.031; odds ratio [OR], 2.537; 95% confidence interval [CI], 1.087–5.925) and tumor response rate ≥47.1% (p=0.001; OR, 3.212; 95% CI, 1.584–6.515) were significantly associated with an increased probability of achieving axillary pCR. The area under the ROC curve for estimating axillary pCR was significantly higher in the model that included tumor response rate than in the model that excluded this rate (0.732 vs. 0.649, p=0.022).ConclusionTumor response rate was the most significant independent predictor of axillary pCR in response to NAC. The model that included tumor response rate was a significantly better predictor of axillary pCR than the model that excluded tumor response rate.

show abstract

Section: Introductionmentioning

confidence: 99%

Improved Model for Predicting Axillary Response to Neoadjuvant Chemotherapy in Patients with Clinically Node-Positive Breast Cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This is in line with previous research given that high-grade tumors are associated with higher rates of axillary pCR. [30][31][32][33] The increasing use of NST and the inability to predict the axillary lymph node status after NST have raised questions regarding the patients who do need PMRT and increased the complexity of immediate breast reconstruction planning. Immediate breast reconstruction reduces the number of surgical procedures and has a better aesthetic outcome due to decreased scarring and preservation of the breast skin envelope.…”

Section: Discussionmentioning

confidence: 99%

Risk of positive sentinel lymph node after neoadjuvant systemic therapy in clinically node negative breast cancer -implications for postmastectomy radiation therapy and immediate breast reconstruction

Samiei

Kaathoven

Boersma

et al. 2020

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Background. Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods. All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results. In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER?HER2?, cT1-3N0 ER-HER2? , and cT1-2N0 triplenegative patients had the lowest rate of positive SLN: 7.2-11.5%, 0-6.3%, and 2.9-6.2%, respectively. cT1-3N0 ER?HER2-and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8-41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01-3.96), cT3 (OR 2.56; 95% CI 1.30-5.38), grade 3 (OR 0.44; 95% CI 0.21-0.91), and ER?HER2-subtype (OR 3.94; 95% CI 1.77-8.74) were correlated with positive SLN. Conclusions. In cT1-3N0 ER?HER2?, cT1-3N0 ER-HER2?, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER?HER2-and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.

show abstract

“…These observations are consistent with previous studies regarding variable sensitivity to chemotherapy, according to tumor grade and subtype . A recent study also revealed that nodal complete response was more likely to be achieved in tumors with high nuclear grade, HER2‐positive tumors, and HR‐negative tumors . HR‐positive breast cancer is known to be less sensitive to NAC, compared with HER2‐positive and triple‐negative breast cancers …”

Section: Discussionmentioning

confidence: 99%

“…Neo‐adjuvant chemotherapy (NAC) is increasingly being used in patients with node‐positive disease . Notably, 40%‐50% of patients convert from node‐positive to node‐negative disease following NAC . The ACOSOG Z1071 and National Surgical Adjuvant Breast and Bowel Project (NSABP) B‐27 trials collectively demonstrated that SLNB, rather than ALND, is applicable for surgical management following NAC .…”

Section: Introductionmentioning

confidence: 99%

Restaging the axilla after neo-adjuvant chemotherapy for breast cancer: Predictive factors for residual metastatic lymph node disease with negative imaging findings

et al. 2019

View full text Add to dashboard Cite

To evaluate predictive factors for residual metastatic axillary lymph node (ALN) disease in patients with negative imaging findings after neo‐adjuvant chemotherapy (NAC) for breast cancer. From January 2011 to December 2015, 206 patients underwent imaging including ultrasonography, MRI, and PET/CT for restaging the axilla after NAC. Data collected included preoperative information regarding histologic grade, hormone receptor (HR) status, and human epidermal growth factor receptor 2 (HER2) status. Multivariate logistic regression analysis was performed to compare patients with and without residual metastatic ALN disease among patients who showed negative imaging findings after NAC. Of the 181 and 25 patients with initially node‐positive and node‐negative disease, 131 (72.4%) and 23 (92.0%), respectively, showed negative imaging findings after NAC. Among these 131 and 23 patients, 53 (40.5%) and two patients (8.7%), respectively, had residual metastatic ALN disease. Low to moderate tumor grade (odds ratio [OR] = 5.2, P = 0.009), positive HR status (OR = 6.6, P = 0.003), and negative HER2 status (OR = 2.6, P = 0.048) were associated with residual metastatic ALN disease. Low to moderate histologic grade, positive HR status, and negative HER2 status may serve as predictors of residual metastatic ALN disease in patients with negative imaging findings after NAC for breast cancer.

show abstract

Nomograms for Predicting Axillary Response to Neoadjuvant Chemotherapy in Clinically Node-Positive Patients with Breast Cancer

Abstract: Nomograms incorporating routine clinicopathologic parameters can predict axillary pCR in node-positive patients receiving NAC and may help to inform treatment decisions.

Cited by 66 publications

References 30 publications

Improved Model for Predicting Axillary Response to Neoadjuvant Chemotherapy in Patients with Clinically Node-Positive Breast Cancer

Improved Model for Predicting Axillary Response to Neoadjuvant Chemotherapy in Patients with Clinically Node-Positive Breast Cancer

Risk of positive sentinel lymph node after neoadjuvant systemic therapy in clinically node negative breast cancer -implications for postmastectomy radiation therapy and immediate breast reconstruction

Restaging the axilla after neo-adjuvant chemotherapy for breast cancer: Predictive factors for residual metastatic lymph node disease with negative imaging findings

Contact Info

Product

Resources

About