How much is the axillary nodal status in breast cancer affected by neoadjuvant chemotherapy? An Alexandria medical research institute hospital experience

Abstract

Background The multidisciplinary approach, including surgery, chemotherapy, endocrine therapy, and radiation therapy, has become the standard treatment for primary breast cancer patients. The status of axillary lymph nodes (AxLNs) remains the most important prognostic factor. The number of lymph nodes retrieved in axillary lymph node dissection (ALND) varies considerably. Removal of at least 10 AxLNs is generally considered as an adequate ALND for reliable lymph node staging. Several authors have reported a significantly lower AxLN count in patients undergoing ALND after the completion of neoadjuvant chemotherapy (NAC) compared with patients who underwent surgical resection first. Objective Our aim was to evaluate the effect of NAC on the axillary nodal status in breast cancer patients regarding the number of AxLNs retrieved at ALND and to compare the degree of response to NAC relative to the primary tumor's nodal status in the both studied groups. Patients and methods In this retrospective study, we reviewed the records of all patients with invasive breast cancer who were admitted to the Department of Surgery, Medical Research Institute hospital, Alexandria, during the period between August 2013 and July 2014 and were scheduled for ALND. Cases were categorized into two groups: group I included patients who received NAC and were then subjected to surgery, whereas group II included patients who were subjected to surgery without NAC. Data collected from both groups included patient demographics and clinicopathological characteristics. Results The study included 237 female patients who were allocated to one of the two groups: group I (GI) included 93 patients (39.2%), whereas group II (GII) included 144 patients (60.8%). There was no statistically significant difference between the two groups regarding the age, the tumor grade, and the tumor type. However, significant differences were seen in a variety of baseline criteria between the two groups; patients who received NAC had larger tumors (T) ( P = 0.001), a higher lymph node ( N ) classification ( P = 0.002), and a higher overall disease stage ( P = 0.0001) compared with patients who underwent surgical resection first. After NAC in GI, AxLNs were significantly more responsive to NAC relative to the primary tumor ( P = 0.003). The number of AxLNs harvested during ALND revealed a significantly lower LNY in patients who underwent NAC in comparison with patients who did not, with a median total number of nine nodes in GI compared with 14 axillary nodes in GII ( P = 0.0001). The number of positive AxLNs was higher in patients who underwent surgical resection first, with a statistically significant difference ( P = 0.006). Conclusion NAC is a significant independent parameter for a reduced AxLN number retrieved by ALND. Also, we can conclude that AxLNs are significantly more responsive to NAC relative to the primary tumor either clinically or pathologically.