Residual Axillary Burden After Neoadjuvant Chemotherapy (NACT) in Early Breast Cancer in Patients with a priori Clinically Occult Nodal Metastases – a transSENTINA Analysis

Hans-Christian Kolberg; Thorsten Kühn; Maja Krajewska; Ingo Bauerfeind; Tanja N. Fehm; Barbara Fleige; Gisela Helms; Annette Lebeau; Annette Stäbler; Sabine Schmatloch; Maik Hauschild; Lukas Schwentner; Peter Schrenk; Sibylle Loibl; Michael Untch; Cornelia Kolberg-Liedtke

doi:10.1055/a-1298-3453

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(12): 1229-1236
DOI: 10.1055/a-1298-3453

GebFra Science

Original Article

Residual Axillary Burden After Neoadjuvant Chemotherapy (NACT) in Early Breast Cancer in Patients with a priori Clinically Occult Nodal Metastases – a transSENTINA Analysis

Residuale axilläre Metastasenlast nach neoadjuvanter Chemotherapie (NAC) bei Patientinnen mit Mammakarzinom im Frühstadium und a priori klinisch-okkulten Lymphknotenmetastasen – eine transSENTINA-Analyse

Authors

Hans-Christian Kolberg

¹Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
Thorsten Kühn

²Interdisciplinary Breast Centre, Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
Maja Krajewska

³Institute of Biometry and Clinical Epidemiology, Charité – University Hospital Berlin, Berlin, Germany
Ingo Bauerfeind

⁴Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
Tanja N. Fehm

⁵Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
Barbara Fleige

⁶Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
Gisela Helms

⁷Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
Annette Lebeau

⁸Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Annette Stäbler

⁹Department of Pathology, University of Tübingen, Tübingen, Germany
Sabine Schmatloch

¹⁰Breast Centre, Elisabeth Hospital Kassel, Kassel, Germany
Maik Hauschild

¹¹Department of Gynecology and Obstetrics, Health Center Fricktal, Rheinfelden, Switzerland
Lukas Schwentner

¹²Gynova, Reith, Austria
Peter Schrenk

¹³Breast Competence Centre, Kepler University Hospital, Linz, Austria
Sibylle Loibl

¹⁴German Breast Group, Neu Isenburg, Germany
Michael Untch

¹⁵Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
Cornelia Kolberg-Liedtke

¹⁶Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany

Abstract

Background Among patients with breast cancer undergoing neoadjuvant chemotherapy (NACT), the association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the association between these parameters and residual axillary involvement after NACT remains unclear.

Methods Patients with clinically occult nodal metastases (i.e. negative by clinical assessment but positive by SLNB prior to NACT, i.e. Arm B of the SENTINA trial) were included in the presented analysis. All patients received a second sentinel lymph node biopsy (SLNB) and axillary dissection after NACT. Univariate and multivariate analyses were carried out to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.

Results Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable for this analysis. After NACT, 71/318 (22.3%) patients had involved SLNs or non-SLNs after NACT. Overall, 71/318 (22.3%) patients achieved a pCR in the breast. Associations of extranodal spread, lack of multifocality and pCR in the breast with residual axillary burden were statistically significant. In a descriptive analysis including all patients with clinically negative axilla before NACT in the SENTINA trial 1.2% of triple negative (TN) patients and 0.5% of HER/2 positive patients had residual axillary disease in case of a breast pCR.

Conclusions Patients in the SENTINA trial with clinically negative axilla and involved SLNs still carried a significant risk of nodal metastases after NACT. However, the risk of residual axillary burden was particularly low in TN and HER/2 positive tumors in case of a breast pCR.

Zusammenfassung

Hintergrund Der Zusammenhang zwischen pathologischer Komplettremission (pCR) der Brust und klinischen/pathologischen Parametern ist bei Brustkrebspatientinnen, die sich einer neoadjuvanten Chemotherapie (NAC) unterziehen, bekannt. Noch nicht geklärt ist aber der Zusammenhang zwischen diesen Parametern und der residualen axillären Lymphknotenlast nach NAC.

Methoden In dieser Studie wurden Patientinnen mit klinisch-okkulten Lymphknotenmetastasen (d. h. klinisch-negativ, aber SLN-positiv vor NAC; d. h. aus dem Arm B der SENTINA-Studie) aufgenommen. Bei allen Patientinnen wurde eine zweite Sentinel-Lymphknoten-Biopsie (SLNB) sowie eine axilläre Lymphknotendissektion nach der NAC durchgeführt. Es wurden univariate und multivariate Analysen durchgeführt, um den Zusammenhang zwischen klinischen/pathologischen Parametern und axillärem Lymphknotenbefall nach NAC zu bestimmen.

Ergebnisse Es wurden 360 Patientinnen aus dem Arm B der SENTINA-Studie in diese Studie aufgenommen, die Daten von 318 dieser Patientinnen wurden analysiert. Nach der NAC wurde bei 71/318 (22,3%) Patientinnen ein Befall der SLN oder Non-SLN festgestellt. Bei insgesamt 71/318 (22,3%) Patientinnen konnte eine pCR der Brust erreicht werden. Der Zusammemhang zwischen extranodaler Ausbreitung, fehlender Multifokalität sowie pCR der Brust und der residualen axillären Lymphknotenlast war statistisch signifikant. Bei der deskriptiven Analyse aller Patientinnen mit klinisch-negativen axillären Lymphknoten vor NAC in der SENTINA-Studie hatten 1,2% der triple-negativen (TN) Patientinnen und 0,5% der HER/2-positiven Patientinnen eine residuale axilläre Tumorlast trotz pCR der Brust.

Schlussfolgerungen Patientinnen der SENTINA-Studie mit klinisch-negativen axillären Lymphknoten und Sentinel-Lymphknoten-Befall haben ein signifikantes Risiko für nodale Metastasen nach NAC. Allerdings ist das Risiko einer residualen axillären Tumorlast besonders gering bei Frauen mit pathologischer Komplettremission der Brust und triple-negativen oder HER/2-positiven Tumoren.

Key words

prediction of lymph node status - primary systemic therapy - SENTINA trial - sentinel lymph node biopsy

Schlüsselwörter

prädiktiver Wert des Lymphknotenstatus - primäre Systemtherapie - SENTINA-Studie - Sentinel-Lymphknoten-Biopsie

Full Text

References

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