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Erschienen in:
25.07.2022 | Breast Oncology
Axillary Staging Is Not Justified in Postmenopausal Clinically Node-Negative Women Based on Nodal Disease Burden
Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2023
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Background
RxPONDER showed no benefit of adjuvant chemotherapy in postmenopausal women with estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer and limited nodal burden (pN1) with a recurrence score ≤ 25, suggesting that axillary staging could be omitted in cN0 patients if significant numbers of such women do not have pN2–3 disease. Here we evaluate the pN2–3 disease rate in a large cohort of postmenopausal women presenting with cN0 breast cancer.
Patients and Methods
Consecutive postmenopausal patients presenting with T1–2N0 breast cancer who underwent axillary surgery from February 2006 to December 2011 were identified. Clinicopathologic characteristics associated with pN2–3 disease were examined using chi-square or Fisher’s exact tests.
Results
Of 3363 postmenopausal women with cT1–2N0 breast cancer (median age 58 years, IQR 48–67 years), median tumor size was 1.3 cm (IQR 0.90–1.90cm). Post-axillary staging, 2600 (77.3%) were pN0, 643 (19.1%) were pN1, and 120 (3.6%) were pN2–3. The pN2-3 disease rate did not differ across subtypes (4.4% HER2+, 3.5% HR−/HER2−, 3.5% HR+/HER2−, p = 0.70). In the subset with HR+/HER2− tumors, on multivariable analysis, age < 65 years (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.32–4.49), lymphovascular invasion (OR 5.29, 95% CI 2.72–11.2), multifocal/centric tumors (OR 3.08, 95% CI 1.79–5.32), and tumor size > 2 cm (OR 5.51, 95% CI 3.05–10.4) were significantly associated with pN2–3 nodal burden. Of 506 patients with tumors > 2 cm, 49 (9.7%) had pN2–3 disease; in the subset of 90 patients age < 65 years who had multifocal/centric tumors > 2 cm, 23 (25.6%) had pN2–3 disease.
Conclusions
In postmenopausal women with cN0 disease, pN2–3 nodal burden is uncommon; omitting axillary staging would not miss a significant number of patients who might benefit from adjuvant chemotherapy. Information available preoperatively indicating a higher risk of nodal disease such as younger age and large, multifocal tumors should be considered in the multidisciplinary management of the axilla.