دورية أكاديمية
Utility of Axillary Staging in Older Patients with HER2-Positive Breast Cancer.
| العنوان: | Utility of Axillary Staging in Older Patients with HER2-Positive Breast Cancer. |
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| المؤلفون: | Dalton JC; Department of Surgery, Duke University Medical Center, Durham, NC, USA., Crowell KA; Duke Cancer Institute, Duke University, Durham, NC, USA., Ntowe KW; Department of Surgery, Duke University Medical Center, Durham, NC, USA., van den Bruele AB; Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Cancer Institute, Duke University, Durham, NC, USA., DiNome ML; Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Cancer Institute, Duke University, Durham, NC, USA., Rosenberger LH; Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Cancer Institute, Duke University, Durham, NC, USA., Thomas SM; Duke Cancer Institute, Duke University, Durham, NC, USA.; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA., Wang T; Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Cancer Institute, Duke University, Durham, NC, USA., Hwang ES; Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Cancer Institute, Duke University, Durham, NC, USA., Plichta JK; Department of Surgery, Duke University Medical Center, Durham, NC, USA. jennifer.plichta@duke.edu.; Duke Cancer Institute, Duke University, Durham, NC, USA. jennifer.plichta@duke.edu.; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA. jennifer.plichta@duke.edu. |
| المصدر: | Annals of surgical oncology [Ann Surg Oncol] 2024 Jul 16. Date of Electronic Publication: 2024 Jul 16. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2005- : New York, NY : Springer Original Publication: New York, NY : Raven Press, c1994- |
| مستخلص: | Background: The utility of sentinel lymph node biopsy (SLNB) in older patients remains controversial. Advancements in human epidermal growth factor receptor 2 (HER2)-directed therapy have revolutionized disease response rates and prognosis, supporting efforts to re-evaluate the utility of SLNB. We aimed to assess the differences in treatment and overall survival (OS) in older patients with HER2-positive breast cancer based on SLNB. Methods: Using the National Cancer Database (2010-2020), patients ≥ 70 years of age diagnosed with cT1-2/cN0/M0, HER2-positive breast cancer were identified. Logistic regression assessed associations with SLNB, systemic therapy, and radiation. Cox proportional hazard models were used to identify factors associated with OS. Analyses were stratified by treatment sequence, i.e. upfront surgery or neoadjuvant therapy (NAT) followed by surgery. Results: Of the 17,609 patients included, 94% underwent upfront surgery (n = 16,492) and the remaining underwent NAT (n = 1117). Those who underwent SLNB were more likely to receive adjuvant therapy, irrespective of nodal status {upfront surgery/systemic therapy (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.17-3.67); upfront surgery/radiation (OR 3.97, 95% CI 3.03-5.21); NAT/radiation (OR 5.69, 95% CI 1.83-17.69)}. The breast pathologic complete response (pCR) rate was highest among the hormone receptor (HR)-negative/HER2-positive subtype (50.0%), of which none were found to be ypN+. Comorbidity burden was associated with significantly lower rates of adjuvant systemic therapy and worse OS. Conclusions: Patients who underwent SLNB, regardless of pN status, were more likely to receive adjuvant therapy. Nodal positivity is exceedingly rare for patients with a breast pCR following NAT, especially among the HR-negative/HER2-positive subtype. It is reasonable to consider omission of SLNB in select subgroups of older patients with HER2-positive breast cancer. (© 2024. Society of Surgical Oncology.) |
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| معلومات مُعتمدة: | K12AR084231 United States GF NIH HHS; P30CA014236 United States GF NIH HHS |
| فهرسة مساهمة: | Keywords: Breast cancer; Elderly; HER2-positive; Neoadjuvant; Pathologic complete response; Sentinel lymph node; Survival |
| تواريخ الأحداث: | Date Created: 20240716 Latest Revision: 20240716 |
| رمز التحديث: | 20240717 |
| DOI: | 10.1245/s10434-024-15812-w |
| PMID: | 39014162 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1534-4681 |
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| DOI: | 10.1245/s10434-024-15812-w |