Impact of neoadjuvant chemotherapy on pathologic axillary nodal status in HER-2 positive patients presenting with clinically node-negative disease.
OBJECTIVE
We investigated the impact of neoadjuvant chemotherapy (NAC) on axillary disease burden in clinically node-negative (cN0) HER-2 positive breast cancer patients.


METHODS
We studied 215 cN0 patients with HER-2 positive tumors. Multivariable logistic regression was used to compare NAC versus primary surgery (PS) with respect to outcome of pathologic nodal disease.


RESULTS
Of 215 patients, 42 (20%) received NAC. NAC use correlated with higher clinical T stage (P < 0.0001) and younger age (P = 0.03) with no difference in ER/PR status or tumor grade. Despite higher clinical T stage in the NAC group, rate of pathologic positive axillary nodes was non-significantly lower (NAC 5/42 = 11.9%, PS 27/173 = 15.6%, P = 0.54). In multivariable analysis, after adjustment for confounders including clinical T stage, age, and multifocal/multicentric disease, NAC showed significant reduction in odds of pathologic nodal disease (OR 0.26, 95%CI:0.06-0.90, P = 0.03). Further, among those with pathologic nodal disease, the number of positive nodes was lower after NAC (adjusted P = 0.03). Extranodal extension was present in 8/27 (30%) PS patients vs. 1/5 (20%) of the NAC patients (adjusted P = 0.36).


CONCLUSIONS
NAC in cN0 HER-2 positive breast cancers reduces the rate of pathologic node-positive disease at operation and nodal disease burden and may decrease the need for axillary node dissection.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Zahraa
Z
Al-Hilli
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Tina J
TJ
Hieken
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Tanya L
TL
Hoskin
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Courtney N
CN
Heins
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Judy C
JC
Boughey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D015996:Survival Rate
D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
HER-2 positive breast cancer; clinically node negative-breast cancer; neoadjuvant chemotherapy