Axillary Lymph Node Dissection Rates and Prognosis From Phase III Neoadjuvant Systemic Trial Comparing Neoadjuvant Chemotherapy With Neoadjuvant Endocrine Therapy in Pre-Menopausal Patients With Estrogen Receptor-Positive and HER2-Negative, Lymph Node-Positive Breast Cancer

Frontiers in Oncology

Seon-Ok Kim¹  Gyungyub Gong²  Wonshik Han³  Eun Sook Lee⁴  Sei Hyun Ahn⁵  Sungchan Gwark⁵  Hee Jeong Kim⁵  Woo Chul Noh⁶  Seok Jin Nam⁷  Yongsik Jung⁸  Lee Su Kim⁹ 

[1] Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea;Department of Pathology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea;Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University, Seoul, South Korea;Department of Surgery, Center for Breast Cancer, Research and Institute and Hospital, National Cancer Center, Goyang, South Korea;Department of Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea;Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea;Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea;Department of Surgery, School of Medicine, Ajou University, Suwon, South Korea;Division of Breast and Endocrine Surgery, College of Medicine, Hallym Sacred Heart Hospital, Hallym University, Anyang, South Korea;

关键词: axillary lymph node dissection;    survival;    prognosis;    neoadjuvant chemotherapy;    neoadjuvant endocrine therapy;    neoadjuvant study of chemotherapy versus Endocrine therapy in premenopausal patient with hormone responsive;   

DOI  :  10.3389/fonc.2021.741120

来源: DOAJ

【 摘 要 】

In this study, we aimed to evaluate axillary lymph node dissection (ALND) rates and prognosis in neoadjuvant chemotherapy (NCT) compare with neoadjuvant endocrine therapy (NET) in estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-), lymph node (LN)-positive, premenopausal breast cancer patients (NCT01622361). The multicenter, phase 3, randomized clinical trial enrolled 187 women from July 5, 2012, to May 30, 2017. The patients were randomly assigned (1:1) to either 24 weeks of NCT including adriamycin plus cyclophosphamide followed by intravenous docetaxel, or NET involving goserelin acetate and daily tamoxifen. ALND was performed based on the surgeon’s decision. The primary endpoint was ALND rate and surgical outcome after preoperative treatment. The secondary endpoint was long-term survival. Among the 187 randomized patients, pre- and post- neoadjuvant systemic therapy (NST) assessments were available for 170 patients. After NST, 49.4% of NCT patients and 55.4% of NET patients underwent mastectomy after treatment completion. The rate of ALND was significantly lower in the NCT group than in the NET group (55.2% vs. 69.9%, P=.046). Following surgery, the NET group showed a significantly higher mean number of removed LNs (14.96 vs. 11.74, P=.003) and positive LNs (4.84 vs. 2.92, P=.000) than the NCT group. The axillary pathologic complete response (pCR) rate was significantly higher in the NCT group (13.8% vs. 4.8%, P=.045) than in the NET group. During a median follow-up of 67.3 months, 19 patients in the NCT group and 12 patients in the NET group reported recurrence. The 5-year ARFS (97.5%vs. 100%, P=.077), DFS (77.2% vs. 84.8%, P=.166), and OS (97.5% vs. 94.7%, P=.304) rates did not differ significantly between the groups. In conclusion, although survival did not differ significantly, more NCT patients might able to avoid ALND, with fewer LNs removed with lower LN positivity.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT01622361, identifier NCT01622361.

【 授权许可】

Unknown