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ER-poor and HER2-positive: a potential subtype of breast cancer to avoid axillary dissection in node positive patients after neoadjuvant chemo-trastuzumab therapy.

Li JW, Mo M, Yu KD, Chen CM, Hu Z, Hou YF, Di GH, Wu J, Shen ZZ, Shao ZM, Liu GY - PLoS ONE (2014)

Bottom Line: After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy.Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B).The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, Shanghai, P. R. China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China.

ABSTRACT

Purpose: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC) with or without trastuzumab in HER2-positive breast cancer.

Methods: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA) before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m2 and carboplatin AUCβ€Š=β€Š2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m2 and carboplatin AUCβ€Š=β€Š6 every-3-week) and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week) or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB) before axillary dissection.

Results: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B). After axillary dissection, the overall pathologically node negative rates (pNNR) were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with β‰₯4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ER-poor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection.

Conclusions: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for accurate axillary evaluation after effective downstaging by neoadjuvant chemo-trastuzumab therapy.

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Related in: MedlinePlus

The retrospective study and testing group designs.HER2β€Š=β€Š human epideminal growth factor receptor 2; cN+β€Š=β€Š clinically axillary node positive; cN-β€Š=β€Š clinically axillary node negative; FNAβ€Š=β€Š fine needle aspiration; Pβ€Š=β€Š paclitaxel; Crbβ€Š=β€Š carboplatin; SLNBβ€Š=β€Š sentinel lymph node biopsy. Some patients received SLNB before axillary dissection in the testing group for exploring the accuracy of SLNB after neoadjuvant therapy.
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pone-0114646-g001: The retrospective study and testing group designs.HER2β€Š=β€Š human epideminal growth factor receptor 2; cN+β€Š=β€Š clinically axillary node positive; cN-β€Š=β€Š clinically axillary node negative; FNAβ€Š=β€Š fine needle aspiration; Pβ€Š=β€Š paclitaxel; Crbβ€Š=β€Š carboplatin; SLNBβ€Š=β€Š sentinel lymph node biopsy. Some patients received SLNB before axillary dissection in the testing group for exploring the accuracy of SLNB after neoadjuvant therapy.

Mentions: We sorted patients to two study groups for both 255 and 46 patients according to the baseline axillary nodal status, determined by both palpation and fine-needle aspiration (FNA), before NAC (Fig. 1). Group-A and C included patients with an axillary node positive status confirmed by FNA (cN+FNA+). Group-B and D included patients with clinically enlarged axillary node(s) that were negative by FNA (cN+/FNA-) or patients with clinically impalpable node (cN-). We classified tumor deposits according to the Union for International Cancer Control TNM classification system [16].


ER-poor and HER2-positive: a potential subtype of breast cancer to avoid axillary dissection in node positive patients after neoadjuvant chemo-trastuzumab therapy.

Li JW, Mo M, Yu KD, Chen CM, Hu Z, Hou YF, Di GH, Wu J, Shen ZZ, Shao ZM, Liu GY - PLoS ONE (2014)

The retrospective study and testing group designs.HER2β€Š=β€Š human epideminal growth factor receptor 2; cN+β€Š=β€Š clinically axillary node positive; cN-β€Š=β€Š clinically axillary node negative; FNAβ€Š=β€Š fine needle aspiration; Pβ€Š=β€Š paclitaxel; Crbβ€Š=β€Š carboplatin; SLNBβ€Š=β€Š sentinel lymph node biopsy. Some patients received SLNB before axillary dissection in the testing group for exploring the accuracy of SLNB after neoadjuvant therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263615&req=5

pone-0114646-g001: The retrospective study and testing group designs.HER2β€Š=β€Š human epideminal growth factor receptor 2; cN+β€Š=β€Š clinically axillary node positive; cN-β€Š=β€Š clinically axillary node negative; FNAβ€Š=β€Š fine needle aspiration; Pβ€Š=β€Š paclitaxel; Crbβ€Š=β€Š carboplatin; SLNBβ€Š=β€Š sentinel lymph node biopsy. Some patients received SLNB before axillary dissection in the testing group for exploring the accuracy of SLNB after neoadjuvant therapy.
Mentions: We sorted patients to two study groups for both 255 and 46 patients according to the baseline axillary nodal status, determined by both palpation and fine-needle aspiration (FNA), before NAC (Fig. 1). Group-A and C included patients with an axillary node positive status confirmed by FNA (cN+FNA+). Group-B and D included patients with clinically enlarged axillary node(s) that were negative by FNA (cN+/FNA-) or patients with clinically impalpable node (cN-). We classified tumor deposits according to the Union for International Cancer Control TNM classification system [16].

Bottom Line: After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy.Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B).The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, Shanghai, P. R. China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China.

ABSTRACT

Purpose: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC) with or without trastuzumab in HER2-positive breast cancer.

Methods: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA) before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m2 and carboplatin AUCβ€Š=β€Š2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m2 and carboplatin AUCβ€Š=β€Š6 every-3-week) and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week) or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB) before axillary dissection.

Results: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B). After axillary dissection, the overall pathologically node negative rates (pNNR) were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with β‰₯4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ER-poor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection.

Conclusions: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for accurate axillary evaluation after effective downstaging by neoadjuvant chemo-trastuzumab therapy.

Show MeSH
Related in: MedlinePlus