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Micrometastases in axillary lymph nodes in breast cancer, post-neoadjuvant systemic therapy

Authors
 Janghee Lee  ;  Seho Park  ;  Soong June Bae  ;  Junghwan Ji  ;  Dooreh Kim  ;  Jee Ye Kim  ;  Hyung Seok Park  ;  Sung Gwe Ahn  ;  Seung Il Kim  ;  Byeong-Woo Park  ;  Joon Jeong 
Citation
 BREAST CANCER RESEARCH, Vol.26(1) : 120, 2024-07 
Journal Title
BREAST CANCER RESEARCH
ISSN
 1465-5411 
Issue Date
2024-07
MeSH
Adult ; Aged ; Axilla* ; Breast Neoplasms* / drug therapy ; Breast Neoplasms* / mortality ; Breast Neoplasms* / pathology ; Breast Neoplasms* / therapy ; Female ; Humans ; Lymph Node Excision* ; Lymph Nodes* / pathology ; Lymphatic Metastasis* ; Middle Aged ; Neoadjuvant Therapy* / methods ; Neoplasm Micrometastasis* ; Prognosis ; Retrospective Studies ; Sentinel Lymph Node / pathology ; Sentinel Lymph Node Biopsy*
Keywords
Axillary lymph node ; Breast cancer ; Micrometastases ; Neoadjuvant systemic therapy ; Sentinel lymph node
Abstract
Introduction: The significance of minimal residual axillary disease, specifically micrometastases, following neoadjuvant systemic therapy (NST) remains largely unexplored. Our study aimed to elucidate the prognostic implications of micrometastases in axillary and sentinel lymph nodes following NST.

Methods: This retrospective study analyzed primary breast cancer patients who underwent surgery after NST from September 2006 through February 2018. All patients received axillary lymph node dissection (ALND), either with or without sentinel lymph node biopsy. Recurrence-free survival (RFS)-associated variables were identified using a multivariate Cox proportional hazard model.

Results: Of the 978 patients examined, 438 (44.8%) exhibited no pathologic lymph node involvement (ypN0) after NST, while 89 (9.1%) had micrometastases (ypN1mi) and 451 (46.7%) had macrometastases (ypN+). Notably, 51.1% of the patients with sentinel lymph node micrometastases (SLNmi) had additional metastases, nearly triple that of SLN-negative patients (P < 0.001), and 29.8% of SLNmi patients were upstaged with the ALND. Although ypN1mi was not associated with RFS in patients post-NST (HR, 1.02; 95% CI, 0.42-2.49; P = 0.958), SLNmi patients experienced significantly worse RFS compared to SLN-negative patients (hazard ratio [HR], 2.23; 95% confidence intervals [CI], 1.12-4.46; P = 0.023). Additional metastases in SLNmi were more prevalent in patients with larger residual breast disease greater than 20 mm, HR-positive/HER2-negative subtype, and low Ki-67 LI (< 14%).

Conclusions: SLNmi is a negative prognostic factor significantly associated with additional non-SLN metastases, while ypN1mi does not influence the prognosis compared to ypN0. Hence, additional ALND may be warranted to confirm axillary nodal status in patients with SLNmi.
Files in This Item:
T202406882.pdf Download
DOI
10.1186/s13058-024-01874-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Il(김승일)
Kim, Jee Ye(김지예) ORCID logo https://orcid.org/0000-0003-3936-4410
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Bae, Soong June(배숭준) ORCID logo https://orcid.org/0000-0002-0012-9694
Ahn, Sung Gwe(안성귀) ORCID logo https://orcid.org/0000-0002-8778-9686
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
Ji, Junghwan(지정환)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201313
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