Highlights
- •cN0 ER+/HER- patients had higher risk of nodal upstaging compared to HER2+ & TNBC.
- •MRI or axillary ultrasound did not modulate risk for nodal upstaging.
- •Compared to NAC, use of NET did not significantly modulate risk for nodal upstaging.
Abstract
Background
Neoadjuvant therapy aims to preoperatively downstage breast cancer patients. We evaluated
nodal upstaging in clinically node-negative (cN0) patients receiving neoadjuvant chemotherapy
(NAC) and neoadjuvant endocrine therapy (NET).
Methods
cN0 patients undergoing neoadjuvant therapy from 2009 to 2018 were reviewed. Univariate
and multivariate analyses evaluated rates of nodal upstaging.
Results
A total of 228 cN0 patients with a mean age of 55 years underwent neoadjuvant therapy
for Stage I-III invasive carcinoma. Subtypes included ER+/HER2- = 93 (40%), HER2+ = 61
(27%), and triple negative (TNBC) = 74 (33%). Among ER+/HER2- patients, 65 (70%) underwent
NET. Overall, 49 patients (21%) were upstaged due to occult nodal disease. Factors
associated with higher rates of occult nodal disease included advanced stage on initial
presentation (P = .008), larger presenting tumor size (P = .009), low/intermediate tumor grade (P = .025), and ER+/HER2- subtype (P < .001); incidence of occult nodal disease by subtype included: ER+/HER2- = 37%, HER2+ = 15%,
TNBC = 8%. Patients experiencing a breast pCR had a significantly lower rate of nodal
upstaging compared to those with residual tumor (4% vs. 96%, P < .001). On multivariate analysis, ER+/HER- patients exhibited higher risk of occult nodal
disease when compared to patients with HER2+ (odds ratio [OR] = 3.4, 95% CI, 1.2-9.8,
P = .003) and TNBC (OR = 5.7, 95% CI, 1.7-19.6, P = .003). Comparing NAC vs. NET in ER+/HER2- patients showed no difference in rates
of occult nodal disease (39% vs. 35%, P = .13).
Conclusions
ER+/HER2- subtype carries higher risk for occult nodal disease after neoadjuvant therapy;
NAC versus NET in these patients does not affect nodal upstaging.
Keywords
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Article info
Publication history
Published online: July 25, 2021
Accepted:
July 10,
2021
Received in revised form:
June 21,
2021
Received:
April 7,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
