Predictive factors for axillary pathological complete response in node-positive breast cancer after neoadjuvant chemotherapy

doi:10.3877/cma.j.issn.1674-0785.2021.10.009

Abstract

Abstract:

Objective

To explore the clinicopathological factors related to axillary pathological complete response (apCR) in axillary lymph node-positive breast cancer after neoadjuvant chemotherapy (NACT), in order to screen out patients who are suitable for avoiding axillary lymph node dissection (ALND).

Methods

A retrospective analysis was performed on primary breast cancer patients with axillary lymph node metastasis who received NACT in the Breast Disease Center of Peking University First Hospital from January 2013 to December 2018. The patients were all female. The patients were divided into either an apCR group or a non-apCR group and the differences of clinicopathological factors between the two groups were compared.

Results

Finally, 194 patients were enrolled in this study. The apCR rate after NACT was 35.1% (68/194). Univariate analysis showed that initial clinical axillary lymph node stage (cN), histological grade, hormone receptor (HR) status, human epidermal growth factor receptor 2 (HER2) status, and breast pathological complete response (bpCR) were correlated with apCR (P＜0.05 for all). Multivariate analysis showed that initial cN status and bpCR were independent predictors of apCR (P＜0.05 for all). Further research found that when initial cN₁ patients obtained a bpCR, all luminal B (HER2 positive) and triple negative breast cancer (TNBC) patients obtained an apCR, while the apCR rate was 88.2% in HER2 overexpressing patients and 50% in patients with the luminal B (HER2 negative) subtype.

Conclusion

If initial cN₁ HER2-positive and triple-negative breast cancer patients obtain a bpCR after NACT, the risk of having residual disease in axillary lymph nodes is extremely low, and they are suitable for further research to avoid ALND.

Key words: Breast neoplasms, Lymph node metastasis, Avoiding axillary surgery

Liangyu Gan, Ling Xin, Yuanjia Cheng, Qian Liu, Jingming Ye, Ling Xu, Xuening Duan, Yinhua Liu. Predictive factors for axillary pathological complete response in node-positive breast cancer after neoadjuvant chemotherapy[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(10): 768-773.

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Figures/Tables 3

临床病理特征	例数	apCR（68例）	未apCR（126例）	统计值	P值
平均年龄（岁， $x ¯$ ±s）	194	51.2±9.9	50.6±10.8	t=1.94	0.165
月经状态				χ²=0.09	0.764
已绝经	97	33（34.0）	64（66.0）
未绝经	97	35（36.1）	62（63.9）
组织学类型				χ²=0.19	0.659
浸润性导管癌	182	65（35.7）	117（64.3）
其他类型或混合型	12	3（25.0）	9（75.0）
初始cT				χ²=4.33	0.228
cT₁	24	8（33.3）	16（66.7）
cT₂	129	51（39.5）	78（60.5）
cT₃	29	6（20.7）	23（79.3）
cT₄	12	3（25.0）	9（75.0）
初始cN				χ²=27.82	＜0.001
cN₁	122	60（49.2）	62（50.8）
cN₂	59	6（10.2）	51（89.8）
cN₃	13	2（15.4）	11（84.6）
乳腺手术方式				χ²=0.18	0.668
保留乳房手术	34	13（38.2）	21（61.8）
乳房全切手术	160	55（34.4）	105（65.6）
组织学分级^a				χ²=6.90	0.009
G1/G2	113	31（27.4）	82（72.6）
G3	81	37（45.7）	44（54.3）
Ki67^b				χ²=0.97	0.326
≤30%	54	16（29.6）	38（70.4）
＞30%	140	52（37.1）	88（62.9）
HR状态				χ²=10.10	0.001
阴性	87	41（47.1）	46（52.9）
阳性	107	27（25.2）	80（74.8）
HER2状态				χ²=7.66	0.006
阴性	106	28（26.4）	78（73.6）
阳性	88	40（45.5）	48（54.5）
bpCR				χ²=54.67	＜0.001
是	44	36（81.8）	8（18.2）
否	150	32（21.3）	118（78.7）

临床病理特征	例数	apCR（68例）	未apCR（126例）	统计值	P值
平均年龄（岁， $x ¯$ ±s）	194	51.2±9.9	50.6±10.8	t=1.94	0.165
月经状态				χ²=0.09	0.764
已绝经	97	33（34.0）	64（66.0）
未绝经	97	35（36.1）	62（63.9）
组织学类型				χ²=0.19	0.659
浸润性导管癌	182	65（35.7）	117（64.3）
其他类型或混合型	12	3（25.0）	9（75.0）
初始cT				χ²=4.33	0.228
cT₁	24	8（33.3）	16（66.7）
cT₂	129	51（39.5）	78（60.5）
cT₃	29	6（20.7）	23（79.3）
cT₄	12	3（25.0）	9（75.0）
初始cN				χ²=27.82	＜0.001
cN₁	122	60（49.2）	62（50.8）
cN₂	59	6（10.2）	51（89.8）
cN₃	13	2（15.4）	11（84.6）
乳腺手术方式				χ²=0.18	0.668
保留乳房手术	34	13（38.2）	21（61.8）
乳房全切手术	160	55（34.4）	105（65.6）
组织学分级^a				χ²=6.90	0.009
G1/G2	113	31（27.4）	82（72.6）
G3	81	37（45.7）	44（54.3）
Ki67^b				χ²=0.97	0.326
≤30%	54	16（29.6）	38（70.4）
＞30%	140	52（37.1）	88（62.9）
HR状态				χ²=10.10	0.001
阴性	87	41（47.1）	46（52.9）
阳性	107	27（25.2）	80（74.8）
HER2状态				χ²=7.66	0.006
阴性	106	28（26.4）	78（73.6）
阳性	88	40（45.5）	48（54.5）
bpCR				χ²=54.67	＜0.001
是	44	36（81.8）	8（18.2）
否	150	32（21.3）	118（78.7）

临床病理特征	回归系数	Wald值	P值	OR值	95%CI
初始cN
cN₂∶cN₁	-2.31	17.06	＜0.001	0.10	0.03~0.30
cN₃∶cN₁	-2.51	6.05	0.014	0.08	0.01~0.60
组织学分级（G3∶G1+G2）	0.69	2.92	0.088	1.99	0.90~4.37
HR状态（阳性∶阴性）	-0.06	0.02	0.878	0.94	0.42~2.10
HER2状态（阳性∶阴性）	0.52	1.7	0.192	1.68	0.77~3.68
乳腺病理状态（非bpCR∶bpCR）	-2.83	27.77	＜0.001	0.06	0.02~0.17

分子亚型	例数	apCR	未apCR
Lumial A^a	2	0（0）	2（100）
Luminal B（HER2-）	69	14（20.3）	55（79.7）
cN₁获得bpCR	2	1（50）	1（50）
cN_2~3获得bpCR	3	1（33.3）	2（66.7）
Luminal B（HER2+）	36	13（36.1）	23（63.9）
cN₁获得bpCR	6	6（100）	0（0）
cN_2~3获得bpCR	1	0（0）	1（100）
HER2（+）	52	27（51.9）	25（48.1）
cN₁获得bpCR	17	15（88.2）	2（11.8）
cN_2~3获得bpCR	5	4（80）	1（20）
TNBC	35	14（40）	21（60）
cN₁获得bpCR	9	9（100）	0（0）
cN_2~3获得bpCR	1	0（0）	1（100）

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