BCa: residual nodal disease after neoadjuvant chemo linked to poorer prognosis

  • Wong SM & al.
  • Ann Surg Oncol
  • 21 Jun 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Low-volume residual nodal disease (i.e., micrometastases or isolated tumor cells [ITCs]) after neoadjuvant chemotherapy (NAC) is associated with around 2 times worse DFS and OS.

Why this matters

  • Findings warrant performance of immunohistochemistry on sentinel nodes after NAC.
  • Nodal micrometastases or ITCs after NAC may warrant further local and systemic therapy.

Study design

  • Analysis of 2 cohorts: cohort 1: 967 patients with cT1-4N0-1 breast cancer treated with NAC at the Dana-Farber/Brigham and Women's Cancer Center (DFBWCC); cohort 2: 35,536 patients in the National Cancer Database (NCDB).
  • Funding: DFBWCC.

Key results

  • DFBWCC cohort:
    • Median follow-up, 5.3 years.
    • Prevalence of ITCs, 2.8%.
    • Prevalence of micrometastases, 6.3%.
    • 5-year DFS (vs node-negative) is worse for patients with ITCs (aHR, 2.36; 95% CI, 1.01-5.51) and micrometastases (aHR, 2.14; 95% CI, 1.20-3.81).
    • No difference in 5-year OS (vs node-negative) for both groups.
  • NCDB cohort:
    • Median follow-up, 3.7 years.
    • Prevalence of ITCs, 1.5%.
    • Prevalence of micrometastases, 3.2%.
    • 5-year OS (vs node-negative) is worse for patients with ITCs (aHR, 1.89; 95% CI, 1.39-2.59) and with micrometastases (aHR, 2.18; 95% CI, 1.76-2.70).

Limitations

  • No data on DFS in the NCDB cohort.
  • Small number of patients in the DFBWCC cohort with nodal micrometastases and ITCs precludes subgroup analysis.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit