Predictive factors for axillary pathological complete response in initially node-positive breast cancer patients treated with neoadjuvant therapy

doi:10.3877/cma.j.issn.1674-0785.2023.10.001

Abstract

Abstract:

Objective

To identify the predictive factors for axillary pathological complete response (apCR) in initially node-positive (cN+) breast cancer patients treated with neoadjuvant treatment (NAT).

Methods

Data of cN+ breast cancer patients treated with NAT at the Breast Department of Sichuan Cancer Hospital from June 2016 to April 2023 were retrospectively reviewed. Clinicopathological characteristics were compared between patients with and without apCR. Univariate and multivariate analyses were conducted for identifying the predictive factors for apCR.

Results

A total of 486 patients were included and the overall apCR rate was 50.4% (245/486). In the univariate analysis, histological grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 index, clinical response, and breast pathological complete response (bpCR) were associated with apCR (P<0.05). Multivariate analysis demonstrated that HER2 positivity (P<0.001), better clinical response, (P=0.047), and bpCR (P<0.001) were independent predictors of apCR. The area under the receiver operating characteristic curve of the prediction model of apCR in cN+ breast cancer patients treated with NAT was 0.793 (95% confidence interval: 0.753-0.833), with a sensitivity of 68.0% and specificity of 81.1%.

Conclusion

In cN+ breast cancer patients treated with NAT, those with HER2 positive disease, better clinical response, or bpCR have a lower risk of axillary residual disease, and can be candidates for de-escalating surgical research.

Key words: Breast cancer, Axillary lymph node metastasis, Neoadjuvant treatment, Axillary pathological complete response, Predictive factor

Exian Mou, Zhuoxuan Li, Hao Dong, Miao Yu, Juan Ji, Jia Xu, Hao Wang, Shiwei Liu. Predictive factors for axillary pathological complete response in initially node-positive breast cancer patients treated with neoadjuvant therapy[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(10): 1027-1032.

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References 19

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临床病理特点	例数（n=486）	apCR（n=245）	非apCR（n=241）	统计值	P值
年龄（岁，）	50.13±9.91	49.38±9.06	50.83±10.65	t=1.381	0.191
BMI（）	24.23±3.20	24.18±10.04	24.28±3.24	t=0.368	0.717
cT[例（%）]				χ²=4.802	0.308
0	2	1（50.0）	1（50.0）
1	37	17（45.9）	20（54.1）
2	358	190（53.1）	168（46.9）
3	63	28（44.4）	35（55.6）
4	26	9（34.6）	17（65.4）
cN[例（%）]				χ²=1.208	0.547
1	333	172（51.7）	161（48.3）
2	79	40（50.6）	39（49.4）
3	74	33（44.6）	41（55.4）
组织学类型[例（%）]				χ²=0.853	0.653
浸润性导管癌	475	240（51.7）	235（48.3）
浸润性小叶癌	8	3（37.5）	5（62.5）
其它类型	3	2（66.7）	1（33.3）
组织学分级[例（%）]				χ²=15.994	<0.001
I~II	238	101（42.4）	137（57.6）
III	124	80（64.5）	44（35.5）
NA	124	64（51.6）	60（48.4）
ER[例（%）]				χ²=17.718	<0.001
阴性	161	103（64.0）	58（36.0）
阳性	325	142（43.7）	183（56.3）
PgR[例（%）]				χ²=17.511	<0.001
阴性	199	123（61.8）	76（38.2）
阳性	287	122（42.5）	165（57.5）
HER2[例（%）]				χ²=85.460	<0.001
阴性	313	109（34.8）	204（65.2）
阳性	173	136（78.6）	37（21.4）
Ki67[例（%）]				χ²=7.148	0.008
<14%	61	22（36.1）	39（63.9）
≥14%	425	223（52.5）	202（47.5）
乳房手术方式[例（%）]				χ²=0.051	0.821
乳房全切	451	228（50.6）	223（49.4）
保留乳房	35	17（48.6）	18（51.4）
临床疗效评价[例（%）]				χ²=21.729	<0.001
CR	15	12（80.0）	3（20.0）
PR	344	189（54.9）	155（45.1）
SD	117	39（33.3）	78（66.7）
PD	10	5（50.0）	5（50.0）
bpCR[例（%）]				χ²=71.526	<0.001
否	340	129（37.9）	211（62.1）
是	146	116（79.5）	30（20.5）

临床病理特点	例数（n=486）	apCR（n=245）	非apCR（n=241）	统计值	P值
年龄（岁，）	50.13±9.91	49.38±9.06	50.83±10.65	t=1.381	0.191
BMI（）	24.23±3.20	24.18±10.04	24.28±3.24	t=0.368	0.717
cT[例（%）]				χ²=4.802	0.308
0	2	1（50.0）	1（50.0）
1	37	17（45.9）	20（54.1）
2	358	190（53.1）	168（46.9）
3	63	28（44.4）	35（55.6）
4	26	9（34.6）	17（65.4）
cN[例（%）]				χ²=1.208	0.547
1	333	172（51.7）	161（48.3）
2	79	40（50.6）	39（49.4）
3	74	33（44.6）	41（55.4）
组织学类型[例（%）]				χ²=0.853	0.653
浸润性导管癌	475	240（51.7）	235（48.3）
浸润性小叶癌	8	3（37.5）	5（62.5）
其它类型	3	2（66.7）	1（33.3）
组织学分级[例（%）]				χ²=15.994	<0.001
I~II	238	101（42.4）	137（57.6）
III	124	80（64.5）	44（35.5）
NA	124	64（51.6）	60（48.4）
ER[例（%）]				χ²=17.718	<0.001
阴性	161	103（64.0）	58（36.0）
阳性	325	142（43.7）	183（56.3）
PgR[例（%）]				χ²=17.511	<0.001
阴性	199	123（61.8）	76（38.2）
阳性	287	122（42.5）	165（57.5）
HER2[例（%）]				χ²=85.460	<0.001
阴性	313	109（34.8）	204（65.2）
阳性	173	136（78.6）	37（21.4）
Ki67[例（%）]				χ²=7.148	0.008
<14%	61	22（36.1）	39（63.9）
≥14%	425	223（52.5）	202（47.5）
乳房手术方式[例（%）]				χ²=0.051	0.821
乳房全切	451	228（50.6）	223（49.4）
保留乳房	35	17（48.6）	18（51.4）
临床疗效评价[例（%）]				χ²=21.729	<0.001
CR	15	12（80.0）	3（20.0）
PR	344	189（54.9）	155（45.1）
SD	117	39（33.3）	78（66.7）
PD	10	5（50.0）	5（50.0）
bpCR[例（%）]				χ²=71.526	<0.001
否	340	129（37.9）	211（62.1）
是	146	116（79.5）	30（20.5）

临床病理因素	apCR（n=245）	OR值（95%CI）	P值
组织学分级			0.186
I-II	101（42.4）	1.00
III	80（64.5）	1.68（0.96~2.93）	0.067
NA	64（51.6）	1.16（0.69~1.94）	0.573
ER			0.580
阴性	103（64.0）	1.00
阳性	142（43.7）	0.83（0.43~1.60）
PgR			0.944
阴性	123（61.8）	1.00
阳性	122（42.5）	1.02（0.55~1.91）
HER2			<0.001
阴性	109（34.8）	1.00
阳性	136（78.6）	4.60（2.86~7.39）
Ki67			0.166
<14%	22（36.0）	1.00
≥14%	223（52.5）	1.63（0.82~3.22）
临床疗效评价			0.047
CR	12（80.0）	1.00
PR	189（54.9）	0.45（0.11~1.86）	0.270
SD	39（33.3）	0.24（0.55~1.02）	0.053
PD	5（50.0）	0.38（0.53~2.71）	0.333
bpCR			<0.001
否	129（37.9）	1.00
是	116（79.5）	3.97（2.40~6.57）

临床病理因素	apCR（n=245）	OR值（95%CI）	P值
组织学分级			0.186
I-II	101（42.4）	1.00
III	80（64.5）	1.68（0.96~2.93）	0.067
NA	64（51.6）	1.16（0.69~1.94）	0.573
ER			0.580
阴性	103（64.0）	1.00
阳性	142（43.7）	0.83（0.43~1.60）
PgR			0.944
阴性	123（61.8）	1.00
阳性	122（42.5）	1.02（0.55~1.91）
HER2			<0.001
阴性	109（34.8）	1.00
阳性	136（78.6）	4.60（2.86~7.39）
Ki67			0.166
<14%	22（36.0）	1.00
≥14%	223（52.5）	1.63（0.82~3.22）
临床疗效评价			0.047
CR	12（80.0）	1.00
PR	189（54.9）	0.45（0.11~1.86）	0.270
SD	39（33.3）	0.24（0.55~1.02）	0.053
PD	5（50.0）	0.38（0.53~2.71）	0.333
bpCR			<0.001
否	129（37.9）	1.00
是	116（79.5）	3.97（2.40~6.57）

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