Abstract
ObjectiveAxillary node status after neoadjuvant chemotherapy (NCT) in early breast cancer patients influences the axillary surgical staging procedure. This study was conducted for the identification of the likelihood of patients being node pathological complete response (pCR) post NCT. We aimed to recognize patients most likely to benefit from sentinel lymph node biopsy (SLNB) following NCT and to reduce the risk of missed detection of positive lymph nodes through the construction and validation of a clinical preoperative scoring prediction model.MethodsThe existing data (from March 2010 to December 2018) of the Chinese Society of Clinical Oncology Breast Cancer Database (CSCO-BC) was used to evaluate the independent related factors of node pCR after NCT by Binary Logistic Regression analysis. A predictive model was established according to the score of considerable factors to identify ypN0. Model performance was confirmed in a cohort of NCT patients treated between January 2019 and December 2019 in Henan Cancer Hospital, and model discrimination was evaluated via assessing the area under the receiver operating characteristic (ROC) curve (AUC).ResultsMultivariate regression analysis showed that the node stage before chemotherapy, the expression level of Ki-67, biologic subtype, and breast pCR were all independent related factors of ypN0 after chemotherapy. According to the transformation and summation of odds ratio (OR) values of each variable, the scoring system model was constructed with a total score of 1–5. The AUC for the ROC curves was 0.715 and 0.770 for the training and the validation set accordingly.ConclusionsA model was established and verified for predicting ypN0 after chemotherapy in newly diagnosed cN+ patients and the model had good accuracy and efficacy. The underlined effective model can suggest axillary surgical planning, and reduce the risk of missing positive lymph nodes by SLNB after NCT. It has great value for identifying initial cN+ patients who are more appropriate for SLNB post-chemotherapy.
Highlights
Sentinel lymph node biopsy (SLNB) is considered to be the standard method for the management of axillary nodes in patients with clinical lymph node-negative early breast cancer (BC)
The following conditions were considered as inclusion criteria [1] cTNM stage based on the 7th edition of American Joint Cancer Commission (AJCC) cTNM staging before treatment available; [2] before chemotherapy, invasive BC validated via core needle biopsy; [3] axillary lymph nodes positive at diagnosis; [4] known estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 status before chemotherapy; [5] received preoperative chemotherapy; [6] received axillary lymph node dissection after chemotherapy, the patient subjected to breast surgery following the local treatment standards; [7] Postoperative pathology of axillary lymph nodes and breast available
The training set area under the ROC curve (AUC) was 0.715, and the verification set SLNB is the standard method for the staging of the axillary lymph node in patients with early BC and cN0 disease
Summary
Sentinel lymph node biopsy (SLNB) is considered to be the standard method for the management of axillary nodes in patients with clinical lymph node-negative (cN0) early breast cancer (BC). The probability of nodal negativity post NCT affects the choice of axillary staging operation. In patients with cN0 disease before treatment, the feasibility of SLNB after chemotherapy has been confirmed and agreed upon. In patients who were downstaged from initial lymph node-positive (cN+) disease before treatment to clinically node-negative after chemotherapy, the safety of SLNB has been confirmed, while it is still one of the focus of controversy [2].
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