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The Loss of Lymph Node Metastases After Neoadjuvant Chemotherapy in Patients With Cytology-proven Axillary Node-positive Primary Breast Cancer



The Loss of Lymph Node Metastases After Neoadjuvant Chemotherapy in Patients With Cytology-proven Axillary Node-positive Primary Breast Cancer



Clinical Breast Cancer 19(4): 278-285



Axillary lymph node (LN) dissection after neoadjuvant chemotherapy (NAC) still remains a standard treatment of initially LN-positive primary breast cancer because of the difficulty of assessment of LN status. The aim of this study was to assess the LN status after NAC in initially LN-positive primary breast cancer patients who were assessed as clinically LN-negative after NAC (ycN0) and identify factors associated with loss of LN metastasis. The study cohort comprised 279 patients with cytology-proven LN-positivity before NAC. LN status was assessed by ultrasonography. Regional recurrence-free survival and overall survival according to pathologic LN after NAC (ypN) status were assessed in patients with ycN0. Of the 279 patients, 179 patients (64.2%) had ycN0. High nuclear grade, estrogen receptor-negative (ER-), and human epidermal growth factor receptor 2-positive (HER2+), were significant predictors of ycN0/ypN0 (P < .001, .007, and .046, respectively). Metastases persisted in 1 or 2 LNs for 5 (20.0%) of 25 patients with ER-/HER2+ and for 4 (21.1%) of 19 patients with ER-/HER2-, and in 3 or more LNs for 0 (0%) of 25 patients with ER-/HER2+ and for 1 (5.3%) of 19 patients with ER-/HER2-. Patients with ER+ tumors had more numerous residual LN metastases than those with ER- tumors (P < .001). Among patients with ycN0, ypN status was not associated with regional recurrence-free survival or overall survival. Three or more residual LN metastases were rare in patients with ER- tumors if assessed as ycN0 by ultrasonography. Prospective studies are needed to confirm the prognostic impact of not performing axillary lymph node dissection in such patients.

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Accession: 066682468

Download citation: RISBibTeXText

PMID: 30975473

DOI: 10.1016/j.clbc.2019.03.001


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