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Management of the axilla in postmenopausal patients with cN0 hormone receptor-positive/HER2-negative breast cancer treated with neoadjuvant endocrine therapy and its prognostic impact

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Abstract

Purpose

To evaluate the differences in nodal positivity if the sentinel lymph node biopsy (SLNB) is performed before or after neoadjuvant endocrine therapy (NET) in breast cancer patients, and its impact on prognosis.

Methods

A retrospective cohort study was performed in a single center including 91 postmenopausal cases with clinically node-negative and hormone receptor-positive/HER2-negative (HR + /HER2−) breast cancer, treated with NET and SLNB. SLNB was done pre-NET until 2014, and post-NET thereafter. Axillary lymph node dissection (ALND) was indicated only in SLNB macrometastasis, although in selected elderly patients, it was omitted. Kaplan–Meier survival curves were estimated in relation to the status of the axilla, and the differences assessed using the log-rank test.

Results

Between December 2006 and March 2022, SLNB was performed pre-NET in 14 cases and post-NET in 77. Both groups were similar in baseline tumor and patient characteristics. SLNB positivity was similar regardless of whether SLNB was performed before (5/14, 35.7%) or after NET (27/77, 37%), with 2/14 SLN macrometastases in the pre-NET cohort and 17/77 in the post-NET cohort. Only three patients (18.7%) with SLN macrometastasis had > 3 positive nodes following ALND. The 5-year overall survival and distant disease-free survival were 92.4% and 94.8%, respectively, with no significant differences according to SLNB status (p 0.5 and 0.8, respectively).

Conclusion

SLN positivity did not differ according to its timing (before or after NET). Therefore, NET has no effect on lymph node clearance. Furthermore, the prognosis is good regardless of the axillary involvement. Therefore, factors other than axillary involvement may affect the prognosis in these patients.

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Data availability

Data were collected from computerized medical histories and the Catalan Public Health computerized network. The system was accessed with non-transferable passwords, ensuring patient confidentiality and privacy. The patient data were also anonymized for the analysis. All confidential patient data were protected according to national standards.

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Acknowledgements

We thank Michael Maudsley for language revision.

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Gynaecology. Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Bellvitge Hospital, Ave. Feixa Llarga, sn Hospitalet de Llobregat, 08970, Barcelona, Spain

    Amparo Garcia-Tejedor, Sergi Fernandez-Gonzalez, Iris Calvo, Hugo Calpelo, Miriam Campos, Jordi Ponce & Maria J. Pla

  2. Department of Medical Oncology. Multidisciplinary Breast Cancer Unit, Institut Català d’Oncología, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain

    Catalina Falo, Miguel Gil-Gil, Agostina Stradella & Sonia Pernas

  3. Department of Oncologic Radiotherapy. Multidisciplinary Breast Cancer Unit, Institut Català d’Oncología. IDIBELL, Barcelona, Spain

    Maria Laplana & Evelyn Martinez-Perez

  4. Department of Pathology. Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Teresa Soler-Monso & Anna Petit

  5. Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Maria-Teresa Bajen & Ana Benitez

  6. Department of Radiology. Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Raul Ortega & Anna Guma

  7. Department of Plastic Surgery. Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain

    Ana Lopez-Ojeda

Authors
  1. Amparo Garcia-Tejedor
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Contributions

AGT, SF, and CF contributed to conceptualization and methodology; SF, IC, HC, and RO contributed to data curation; AGT, IC, and HC contributed to formal analyses; AGT, CF, SP, and ML contributed to writing original draft preparation ; SF, MG, TS, EM, MJP, AG, MB, AB, RO, AP, JP, EF, MC, AL, and SP contributed to writing, review, and editing. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Amparo Garcia-Tejedor or Sonia Pernas.

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Conflict of interest

S.P. has served as an advisor/consultant for AstraZeneca, Daiichi Sankyo Eisai, Novartis, Polyphor, Roche, Pierre-Fabre, Pfizer, and SeattleGenetics. All other authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Hospital Universitari de Bellvitge (protocol code 247/06, approved in November 2006).

Informed consent

Informed consent was obtained from all study participants.

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Garcia-Tejedor, A., Falo, C., Fernandez-Gonzalez, S. et al. Management of the axilla in postmenopausal patients with cN0 hormone receptor-positive/HER2-negative breast cancer treated with neoadjuvant endocrine therapy and its prognostic impact. Breast Cancer Res Treat 199, 445–456 (2023). https://doi.org/10.1007/s10549-023-06926-y

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