Abstract
Prognostic implications of therapeutic response of metastatic lymph nodes (LNs) to neoadjuvant chemotherapy (NAC) remain unclear in patients with breast cancer. We aimed to evaluate the prognostic value of axillary LN regression after NAC in locally-advanced breast cancer patients. Therapeutic response of the LNs was evaluated in 563 breast cancer patients and classified into four grades according to the regression pattern. Initial pathologic N stage was estimated from the sum of the metastatic LNs and those with complete regression. In survival analyses, LN regression grade, pathologic N stage after NAC, and presumed initial pathologic N stage stratified clinical outcome of the patients in the whole group, in both ER-positive and ER-negative subgroups, and in those with residual breast disease. On multivariate analysis, LN regression grade and presumed initial pathologic N stage were revealed as independent prognostic factors. The number of completely-responsive LNs and the ratio of non-responsive LNs also revealed a prognostic value. In conclusion, regression grade of axillary LNs and presumed initial pathologic N stage have prognostic values in breast cancer patients who receive NAC. Thus, regression of axillary LNs should be evaluated and included in pathologic reporting of post-NAC resection specimens.
Highlights
Prognostic implications of therapeutic response of metastatic lymph nodes (LNs) to neoadjuvant chemotherapy (NAC) remain unclear in patients with breast cancer
We evaluated the regression of metastatic LNs, estimated initial pathologic N stage, and assessed their prognostic value in predicting survival of the patients with locally advanced breast cancer treated with NAC
The AC regimen consisting of doxorubicin and cyclophophamide for 4 to 6 cycles was given to 142 patients (25.2%), sequential AC-T comprising 4 cycles of AC followed by 4 cycles of docetaxel was administered in 271 patients (48.1%), and sequential AC-TH comprising 4 cycles of AC followed by 4 cycles of docetaxel and trastuzumab was given to 54 patients (9.6%)
Summary
Prognostic implications of therapeutic response of metastatic lymph nodes (LNs) to neoadjuvant chemotherapy (NAC) remain unclear in patients with breast cancer. Regression grade of axillary LNs and presumed initial pathologic N stage have prognostic values in breast cancer patients who receive NAC. More detailed indices including Miller-Payne grading system which reflect cellularity difference between pre- and post-treatment tumors and the Residual Cancer Burden (RCB) classification that incorporates both primary and axillary tumor burden have been d evised[3,4] These systems reflect chemo-responsiveness of a tumor and predict patients’ clinical o utcome[4,5]. We evaluated the regression of metastatic LNs, estimated initial pathologic N stage, and assessed their prognostic value in predicting survival of the patients with locally advanced breast cancer treated with NAC
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