Axillary staging is not justified in postmenopausal clinically node-negative women based on nodal disease burden Journal Article
| Authors: | Lee, M. K.; Montagna, G.; Pilewskie, M. L.; Sevilimedu, V.; Morrow, M. |
| Article Title: | Axillary staging is not justified in postmenopausal clinically node-negative women based on nodal disease burden |
| Abstract: | Background: RxPONDER showed no benefit of adjuvant chemotherapy in postmenopausal women with estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer and limited nodal burden (pN1) with a recurrence score ≤ 25, suggesting that axillary staging could be omitted in cN0 patients if significant numbers of such women do not have pN2–3 disease. Here we evaluate the pN2–3 disease rate in a large cohort of postmenopausal women presenting with cN0 breast cancer. Patients and Methods: Consecutive postmenopausal patients presenting with T1–2N0 breast cancer who underwent axillary surgery from February 2006 to December 2011 were identified. Clinicopathologic characteristics associated with pN2–3 disease were examined using chi-square or Fisher’s exact tests. Results: Of 3363 postmenopausal women with cT1–2N0 breast cancer (median age 58 years, IQR 48–67 years), median tumor size was 1.3 cm (IQR 0.90–1.90cm). Post-axillary staging, 2600 (77.3%) were pN0, 643 (19.1%) were pN1, and 120 (3.6%) were pN2–3. The pN2-3 disease rate did not differ across subtypes (4.4% HER2+, 3.5% HR−/HER2−, 3.5% HR+/HER2−, p = 0.70). In the subset with HR+/HER2− tumors, on multivariable analysis, age < 65 years (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.32–4.49), lymphovascular invasion (OR 5.29, 95% CI 2.72–11.2), multifocal/centric tumors (OR 3.08, 95% CI 1.79–5.32), and tumor size > 2 cm (OR 5.51, 95% CI 3.05–10.4) were significantly associated with pN2–3 nodal burden. Of 506 patients with tumors > 2 cm, 49 (9.7%) had pN2–3 disease; in the subset of 90 patients age < 65 years who had multifocal/centric tumors > 2 cm, 23 (25.6%) had pN2–3 disease. Conclusions: In postmenopausal women with cN0 disease, pN2–3 nodal burden is uncommon; omitting axillary staging would not miss a significant number of patients who might benefit from adjuvant chemotherapy. Information available preoperatively indicating a higher risk of nodal disease such as younger age and large, multifocal tumors should be considered in the multidisciplinary management of the axilla. © 2022, Society of Surgical Oncology. |
| Keywords: | adult; aged; middle aged; major clinical study; clinical feature; histopathology; cancer staging; tumor volume; cohort analysis; breast neoplasms; risk factor; axillary lymph node; breast tumor; clinical evaluation; multivariate analysis; postmenopause; cost of illness; clinical examination; lymph vessel metastasis; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; disease burden; humans; human; female; article; human epidermal growth factor receptor 2 negative breast cancer; multiple tumor |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 30 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2023-01-01 |
| Start Page: | 92 |
| End Page: | 97 |
| Language: | English |
| DOI: | 10.1245/s10434-022-12203-x |
| PUBMED: | 35876927 |
| PROVIDER: | scopus |
| PMCID: | PMC10331920 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author Monica Morrow -- Export Date: 3 January 2023 -- Source: Scopus |
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