Positive sentinel node in luminal A-like breast cancer patients - implications for adjuvant chemotherapy?

Tullberg, Axel Stenmark; Lundstedt, Dan; Bagge, Roger Olofsson; Karlsson, Per

doi:10.1080/0284186x.2018.1533647

Cited by 10 publications

(13 citation statements)

References 29 publications

(29 reference statements)

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“…Oncologists define luminal A as estrogen receptor (ER) > 1%, progesterone receptor (PR) ≥ 20%, breast cancer with negative human epidermal growth factor receptor-2 (HER2), and Ki-67 < 14% of clinical cases [4]. Luminal A has high hormone receptor expression, negative HER2 expression, and a low proliferation rate, properties that contribute to its better prognosis [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

2020

World J Surg Onc

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Objective To assess the association between chemotherapy and prognosis of patients with breast cancer of luminal A subtype and lymph node-positive, luminal A subtype breast cancer Methods Articles published between January 1, 2010, and May 1, 2020, were collected from PubMed, Embase, and Web of Science databases. On the basis of a test for heterogeneity, we selected the random effects model or fixed effects model for meta-analysis. Article quality was evaluated by sensitivity analysis, and Begg’s and Egger’s tests were used to measure publication bias. Results Six eligible articles were identified. The hazard ratio of overall survival of luminal A breast cancer patients who received both chemotherapy and endocrine therapy was 1.73 (95% CI 1.23, 2.43). The hazard ratio of overall survival for lymph node-positive, luminal A breast cancer patients who received chemotherapy and endocrine therapy was 1.86 and 95% CI 1.26, 2.81. The hazard ratio of relapse-free survival to disease-free survival was 1.30 (95% CI 0.85, 1.77). Tumor size, vascular invasion, and age did not show significant correlations with breast cancer prognosis. Conclusion Compared with endocrine therapy alone, the addition of chemotherapy did not improve the prognosis of patients with luminal type A and lymph node positive cancer; instead, side effects of the additional chemotherapy may have negatively affected prognosis. Prospective studies are needed to determine whether the number of positive lymph nodes also correlates with efficacy of chemotherapy of luminal type A breast cancer.

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Section: Introductionmentioning

confidence: 99%

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

2020

World J Surg Onc

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“…The associations between pN stage and both tumor size and T stage were shown in ER-positive/HER2-negative BC by Noda et al [ 33 ]. Several other authors have obtained similar results [ 45 ], but some did not show any relationships between tumor size and lymph node involvement in luminal A BC [ 46 ]. Our study showed that patient age does not correlate with lymph node involvement in this molecular subtype.…”

Section: Discussionmentioning

confidence: 66%

Nodal status in luminal A invasive breast cancer: relationships with cytotoxic CD8 + and regulatory FOXP3 + cells tumor-associated infiltrate and other prognostic factors

et al. 2021

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Luminal A breast cancers are generally associated with low metastatic potential and good prognosis. However, there is a proportion of patients, who present with metastases in lymph nodes. The aim of our study was to determine the association between the number of positive lymph nodes and infiltrates of tumor-associated cytotoxic CD8 + (CTLs), regulatory FOXP3 + T cells (Tregs), as well as other prognostic factors. Immunohistochemistry (IHC) for CD8 + and FOXP3 + was performed in 87 formalin-fixed paraffin-embedded primary breast cancer tissues, and cell infiltrate was assessed under light microscope. We observed that node-positive cases were associated with higher numbers of Treg cells and lower CTL/Treg ratio. There was also an inverse correlation between the CTL/Treg ratio and the number of metastatic lymph nodes. Similar relationships were found between the number of metastatic lymph nodes and Treg density or CTL/Treg ratio in pT1 BC. An elevated intratumoral CTL/Treg ratio was associated with pN0 stage. The relationship between lymphovascular invasion (LVI) and Treg density was also noted in node-negative tumors. In addition, more advanced nodal stage was related to LVI, higher pT, and lower PR expression. The numbers of CD8 + and FOXP3 + were also associated with tumor size, histologic grade, PR expression, and mitotic index. The results of our study suggested that the levels of tumor-infiltrating regulatory and cytotoxic cells as well as the balance between them play a role in lymphovascular spread of luminal A breast cancers.

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“…Previous breast cancer studies exploring the impact of nodal staging data on adjuvant treatment decision, have not specified the histological subtypes and are based on smaller cohorts than ours 42,43 36 . In the seminal trials, a majority of the included patients had micrometastasis only in their SLNs and isolated tumor cells were classified as micrometastasis 44 , and ≥ 90% of the patients received adjuvant systemic treatment.…”

Section: Discussionmentioning

confidence: 94%

“…Previous breast cancer studies exploring the impact of nodal staging data on adjuvant treatment decision, have not specified the histological subtypes and are based on smaller cohorts than ours 42,43 Studies investigating ALN status in relation to histological subtype, have shown a higher axillary metastatic burden in ILC compared to NST, but the total number of patients with ILC, strictly eligible for omission of cALND according to the Z0011 criteria and with both SLN and non-SLN data available, is low (n = 2-24); and complete data from those meeting the St. Gallen 2019 guidelines are for the most part either missing or not reported 17,19,[45][46][47] .…”

Section: Discussionmentioning

confidence: 94%

The St. Gallen 2019 Guidelines understages the Axilla in Lobular Breast Cancer – a Population-Based Study

Narbe

Bendahl

Fernö

et al. 2021

Preprint

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Background The St. Gallen 2019 guidelines recommend omission of completion axillary lymph node dissection (cALND) in breast cancer patients with 1-2 sentinel lymph node (SLN) metastases regardless of histopathology. Concurrently, adjuvant chemotherapy is endorsed for luminal A-like disease with ≥4 axillary lymph node (ALN) metastases. We aimed to estimate the proportion of patients with invasive lobular cancer (ILC) and invasive ductal cancer of no special type (NST) and 1-2 SLN metastases for whom cALND would indicate need of adjuvant chemotherapy. Methods Patients with ILC and NST histopathology undergoing primary surgery 2014-2017 were identified in the Swedish National Quality Breast Cancer register. After exclusion of patients with incongruent or missing data, 1886 patients who fulfilled the St. Gallen 2019 criteria for cALND omission were included in the study cohort. Results Patients with ILC (n = 329) had a higher metastatic nodal burden and more often a luminal A-like subtype compared with NST patients (n = 1507). The prevalence of ≥ 4 ALN metastases was higher in ILC (31%) than in NST (15%), corresponding to an adjusted odds of 2.26 (95% CI 1.59-3.21). Luminal A-like breast cancers with ≥4 ALN metastases were overrepresented in ILC cases (52/281 (19%)) compared to NST cases (43/1299 (3%)), P<0.001. Conclusions Patients with ILC more often had a luminal A-like breast cancer with ≥4 ALN metastases compared with NST patients. Abstaining cALND in patients with luminal A-like ILC with 1-2 SLN metastases warrants future attention as it risks nodal understaging and hence undertreatment in one-fifth of these patients.

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Positive sentinel node in luminal A-like breast cancer patients - implications for adjuvant chemotherapy?

Cited by 10 publications

References 29 publications

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

Efficacy of chemotherapy for lymph node-positive luminal A subtype breast cancer patients: an updated meta-analysis

Nodal status in luminal A invasive breast cancer: relationships with cytotoxic CD8 + and regulatory FOXP3 + cells tumor-associated infiltrate and other prognostic factors

The St. Gallen 2019 Guidelines understages the Axilla in Lobular Breast Cancer – a Population-Based Study

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