Details

Autor(en) / Beteiligte

• Weber, Walter P
• Matrai, Zoltan
• Hayoz, Stefanie
• Tausch, Christoph
• Henke, Guido
• Zimmermann, Frank
• Montagna, Giacomo
• Fitzal, Florian
• Gnant, Michael
• Ruhstaller, Thomas
• Muenst, Simone
• Mueller, Andreas
• Lelièvre, Loïc
• Heil, Jörg
• Knauer, Michael
• Egle, Daniel
• Sávolt, Ákos
• Heidinger, Martin
• Kurzeder, Christian
• Zwahlen, Daniel R
• Gruber, Günther
• Ackerknecht, Markus
• Kuemmel, Sherko
• Bjelic-Radisic, Vesna
• Smanykó, Viktor
• Vrieling, Conny
• Satler, Rok
• Hagen, Daniela
• Becciolini, Charles
• Bucher, Susanne
• Simonson, Colin
• Fehr, Peter M
• Gabriel, Natalie
• Maráz, Robert
• Sarlos, Dimitri
• Dedes, Konstantin J
• Leo, Cornelia
• Berclaz, Gilles
• Fansa, Hisham
• Hager, Christopher
• Reisenberger, Klaus
• Singer, Christian F
• Loibl, Sibylle
• Winkler, Jelena
• Lam, Giang Thanh
• Fehr, Mathias K
• Kohlik, Magdalena
• Clerc, Karine
• Ostapenko, Valerijus
• Maggi, Nadia
• Schulz, Alexandra
• Andreozzi, Mariacarla
• Goldschmidt, Maite
• Saccilotto, Ramon
• Markellou, Pagona

Titel

Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer

Ist Teil von

• JAMA surgery, 2023-10, Vol.158 (10), p.1013

Ort / Verlag

United States

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)-positive breast cancer (BC) is currently unknown. To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT). This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required. All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators. A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)-positive and Erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine-DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]). Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.