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Impact of Neoadjuvant Chemotherapy on Nodal Disease and Nodal Surgery by Tumor Subtype

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NAC) is known to downstage disease in the breast and increase breast conservation. It can also decrease nodal disease extent. We evaluated the impact of NAC on nodal positivity, nodal burden, and nodal surgery by tumor subtype.

Methods

All cT1–4c breast cancers from 2010 to 2014 in the National Cancer Database were evaluated, comparing patients receiving NAC with those undergoing primary surgery (PS). Rates of pathologic node-negative status (pN0) and sentinel lymph node (SLN) surgery (1–5 nodes) were compared using chi-square tests, and adjusted odds ratios (OR) were estimated.

Results

Of 461,549 patients, 36,715 (8.0%) received NAC and 424,834 (92.0%) had PS. In cN0 patients, pN0 rates were higher in NAC compared with PS patients in ER−/HER2+ [93.2 vs. 79.0%, odds ratio (OR) 3.64, p < 0.001], ER−/HER2− (89.9 vs. 85.2%, OR 1.55, p < 0.001), and ER+/HER2+ (84.7 vs. 78.3%, OR 1.54, p < 0.001). Patients with cT2–3, N0 tumors had significantly higher rate of SLN surgery for NAC versus PS for each biologic subtype except for ER+/HER2− tumors, amongst which this was true only for T3 tumors. In cN1–3 patients, pN0 rates after NAC were 61.3% in ER−/HER2+, 47.7% in ER+/HER2+, 47.3% in ER−/HER2−, and 20.2% in ER+/HER2− and SLN surgery was highest in ER−/HER2+ (28.9%, p < 0.05 versus other subtypes).

Conclusion

NAC increases rates of pN0 among cN0 patients compared with PS. Among cN+ patients, 20–61% undergoing NAC convert to pN0 depending on tumor type, with lowest nodal response in ER+/HER2− disease. Use of NAC results in less extensive axillary surgery than in patients treated with PS in both cN0 and cN+ disease.

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Acknowledgement

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study were derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Zahraa Al-Hilli MD & Judy C. Boughey MD

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS & Courtney N. Day BS

  3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann Ph.D

Authors
  1. Zahraa Al-Hilli MD
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  2. Tanya L. Hoskin MS
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  3. Courtney N. Day BS
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  4. Elizabeth B. Habermann Ph.D
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  5. Judy C. Boughey MD
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Corresponding author

Correspondence to Judy C. Boughey MD.

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Al-Hilli, Z., Hoskin, T.L., Day, C.N. et al. Impact of Neoadjuvant Chemotherapy on Nodal Disease and Nodal Surgery by Tumor Subtype. Ann Surg Oncol 25, 482–493 (2018). https://doi.org/10.1245/s10434-017-6263-y

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  • DOI: https://doi.org/10.1245/s10434-017-6263-y

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