Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery.

Faleh S ¹,

Prakash I ^{1,

2},

Salehi A ²,

Khan H ^{1,

2},

Affiliations

1. Department of Surgery, McGill University Medical School, Montreal, QC, Canada.
Authors
Faleh S¹
Prakash I^{1,

2}
Khan H^{1,

2}
Basik M^{1,

2}
Boileau JF^{1,

2}
Tejera D^{1,

2}
Martel K^{1,

2}
Meterissian S¹
Wong SM^{1,

2}
(9 authors)
2. Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada.
Authors
Prakash I^{1,

2}
Salehi A²
Khan H^{1,

2}
Basik M^{1,

2}
Boileau JF^{1,

2}
Tejera D^{1,

2}
Panet F²
Martel K^{1,

2}
Wong SM^{1,

2}
(9 authors)

ORCIDs linked to this article

Wong SM | 0000-0002-6850-2192

Breast Cancer Research and Treatment, 21 Feb 2024, 205(2):303-312
https://doi.org/10.1007/s10549-024-07251-8 PMID: 38381275

Abstract

Purpose

The goal of this study was to identify the preoperative predictors of pathologic nodal metastases (pN+) in cT1cN0 HER2+ breast cancer undergoing upfront surgery.

Methods

We retrospectively reviewed data from women with cT1-T2N0 HER2+ breast cancer treated with neoadjuvant therapy (NAC) or upfront surgery at our institution between 2012 and 2023. Factors associated with management strategy were evaluated, and in those undergoing upfront surgery, univariate analyses were performed to identify the clinicopathologic factors associated with nodal metastases.

Results

Overall, 255 women with cT1-T2N0 HER2+ breast cancer met inclusion criteria, including 170 (68.6%) upfront surgery patients and 85 (31.4%) who underwent NAC. The median age at diagnosis was 59 years (range, 27-90 years). Younger age, larger clinical tumor size, high-grade disease, ER-PR-HER2+ subtype, and year of diagnosis after 2019 were significantly associated with receipt of NAC (p < 0.05). In those undergoing upfront surgery, 25.3% were pN+ , including 32.5% of cT1cN0 tumors. Factors associated with nodal involvement included age under 50, larger clinical tumor size, lymphovascular invasion (LVI), multifocality/multicentricity, and abnormal lymph nodes on axillary ultrasound (p < 0.05). In subset analysis of cT1cN0 HER2+ cases, LVI remained the strongest predictor of pN + disease (73.3% vs. 22.6%, p < 0.001). Patients with cT1cN0 HER2+ breast cancer under 50 years had a 47.1% likelihood of pN+ disease.

Conclusion

Patients with cT1cN0 breast cancer have a 32.5% likelihood of nodal metastases, with higher incidence with younger age, LVI, multifocality/multicentricity, and abnormal axillary ultrasound. The presence of these factors may identify the patients who would benefit from treatment with neoadjuvant chemotherapy.

Full text links

Read article at publisher's site: https://doi.org/10.1007/s10549-024-07251-8

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Comparison of the effectiveness of neoadjuvant chemotherapy and adjuvant chemotherapy for improving prognosis in triple-negative breast cancer patients.
Li W, Chang Y, Bai X, Cao H
Am J Transl Res, 16(8):3978-3989, 15 Aug 2024
Cited by: 0 articles | PMID: 39262758 | PMCID: PMC11384378
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Fonds de Recherche du Québec - Santé (1)

Grant ID: 309854
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Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery.

Affiliations

ORCIDs linked to this article

Abstract

Purpose

Methods

Results

Conclusion

Full text links

References

US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status.

Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer.

Seven-Year Follow-Up Analysis of Adjuvant Paclitaxel and Trastuzumab Trial for Node-Negative, Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer.

Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: final 10-year analysis of the open-label, single-arm, phase 2 APT trial.

Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE.

St. Gallen/Vienna 2023: Optimization of Treatment for Patients with Primary Breast Cancer - A Brief Summary of the Consensus Discussion.

The evolving understanding of small HER2-positive breast cancers: matching management to outcomes.

Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer.

Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients.

Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA).

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Article citations

Comparison of the effectiveness of neoadjuvant chemotherapy and adjuvant chemotherapy for improving prognosis in triple-negative breast cancer patients.

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Preoperative factors that predict pathologic nodal involvement in early-stage HER2+ breast cancer: selecting cT1cN0 patients for treatment with neoadjuvant chemotherapy versus upfront surgery.

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Funding

Fonds de Recherche du Québec - Santé (1)﻿

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Fonds de Recherche du Québec - Santé (1)