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Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial

Bernd Gerber, Andreas Schneeweiss, Volker Möbus, Michael Golatta, Hans Tesch, David Krug, Claus Hanusch, Carsten Denkert, Kristina Lübbe, Jörg Heil, Jens Huober, Beyhan Ataseven, Peter Klare, Markus Hahn, Michael Untch, Karin Kast, Christian Jackisch, Jörg Thomalla, Fenja Seither, Jens-Uwe Blohmer, Kerstin Rhiem, Peter A Fasching, Valentina Nekljudova, Sibylle Loibl & Thorsten Kühn

abstract

BACKGROUND
The conversion of initially histologically confirmed axillary lymph node-positive (pN+) to ypN0 after neoadjuvant systemic treatment (NAST) is an important prognostic factor in breast cancer (BC) patients and may influence surgical de-escalation strategies. We aimed to determine pCR rates in lymph nodes (pCR-LN), the breast (pCR-B), and both (tpCR) in women who present with pN+ BC, to assess predictors for response and the impact of pCR-LN, pCR-B, and tpCR on invasive disease-free survival (iDFS).

METHODS
Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial.

RESULTS
Of 242 patients with initially pN+ disease, 134 (55.4%) had a pCR-LN, and 109 (45.0%) a pCR-B. Of the 109 pCR-B patients, 9 (8.3%) patients had involved LN, and 100 (41.3%) patients had tpCR. Those with involved LN still had a bad prognosis. As expected, pCR-B and intrinsic subtypes (TNBC and HER2+) were identified as independent predictors of pCR-LN. pCR-LN (ypN0; hazard ratio 0.42; 95%, CI 0.23-0.75; = 0.0028 for iDFS) was the strongest independent prognostic factor.

CONCLUSIONS
In initially pN+ patients undergoing NAST, the conversion to ypN0 is of high prognostic value. Surgical axillary staging after NAST is still essential in these patients to offer tailored treatment.
   
citation Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Hanusch C, Denkert C, Lübbe K, Heil J, Huober J, Ataseven B, Klare P, Hahn M, Untch M, Kast K, Jackisch C, Thomalla J, Seither F, Blohmer J U, Rhiem K, Fasching P A, Nekljudova V, Loibl S, Kühn T. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers (Basel) 2022; 14:.
   
type journal paper/review (English)
date of publishing 20-01-2022
journal title Cancers (Basel) (14/3)
ISSN print 2072-6694
PubMed 35158789
DOI 10.3390/cancers14030521