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Association of Tumor Molecular Subtype and Stage with Breast and Axillary Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer

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

Abstract

Background

Axillary pathologic complete response (pCR) confers higher overall and recurrence-free survival than residual axillary disease. Although breast pCR (ypT0) is associated with a pathologically negative axilla (ypN0) in human epidermal growth factor receptor 2-positive (HER2+) and triple-negative breast cancer (TNBC), how clinical T (cT) and N (cN) staging are associated with ypN0 in other tumor subtypes is incompletely understood.

Methods

A single-institution cancer registry was retrospectively reviewed for patients receiving neoadjuvant chemotherapy (NAC) followed by surgery from 2010 to 2018. Fisher’s exact tests compared proportion of breast and axillary pCR by tumor subtype (hormone receptor [HR]-positive /HER2–,HR+/HER2+,HR–/HER2+,HR–/HER2–). Logistic regression determined factors associated with ypN0. Sensitivity analyses determined how cN status affected ypN status by tumor subtype.

Results

The study enrolled 1348 patients. The median age was 54 years (interquartile range [IQR], 44–63 years), and 55% of the patients (n = 736) were postmenopausal. The tumor subtypes were HR+/HER2– (12%, n = 155), HR+/HER2+ (48%, n = 653), HR–/HER2+ (25%, n = 343), and TNBC (15%, n = 197). In the study, cT included T0 (1%, n = 18), T1 (20%, n = 272), T2 (53%, n = 713), T3 (17%, n = 230), and T4 (9%, n = 111), and cN included cN0 (51%, n = 687), cN1 (41%, n = 549), cN2 (5%, n = 61), and cN3 (3%, n = 43). Breast pCR and ypN0 occurred most in the HER2+ and TNBC subtypes. A negative association was found between ypN0 and age at diagnosis (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97–0.99; p < 0.001), cT4 stage (OR, 0.29; 95% CI, 0.09–0.91; p = 0.034), and HR+ subtypes (HR+/HER2–: OR, 0.54; 95% CI, 0.31–0.94; p = 0.028; HR+/HER2+: OR, 0.60; 95% CI, 0.39–0.93; p = 0.024). The HR–/HER2+ subtype was associated with ypN0 (OR, 1.70; 95% CI, 1.05–2.73; p = 0.030), and cN2/cN3 was negatively associated with ypN0 in HR+/HER2+ disease (OR, 0.26; 95% CI, 0.11–0.61; p = 0.002), HR–/HER2+ disease (OR, 0.42; 95% CI, 0.22–0.77; p = 0.005), and TNBC (OR, 0.11; 95% CI, 0.03–0.40; p = 0.001).

Conclusion

Tumor subtype, clinical stage, and age at diagnosis may be important in consideration of de-escalation of axillary staging.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Sara P. Myers MD, PhD & Gillian M. Ahrendt BS

  2. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Joanna S. Lee MD, Jennifer G. Steiman MD, Atilla Soran MD, MPH, Ronald R. Johnson MD, Priscilla F. McAuliffe MD, PhD & Emilia J. Diego MD

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  1. Sara P. Myers MD, PhD
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  2. Gillian M. Ahrendt BS
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Correspondence to Sara P. Myers MD, PhD.

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Myers, S.P., Ahrendt, G.M., Lee, J.S. et al. Association of Tumor Molecular Subtype and Stage with Breast and Axillary Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 28, 8636–8642 (2021). https://doi.org/10.1245/s10434-021-10195-8

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