Predictive Factors and Value of ypN after Neoadjuvant Chemotherapy in Clinically Lymph Node-Negative Breast CancerReportar como inadecuado




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Background

Pathological complete response pCR with neoadjuvant chemotherapy NAC has been regarded as a surrogate endpoint for disease-free survival DFS and overall survival OS of patients with breast cancer. No consensus regarding the definition of pCR has been established; there are several definitions according to a variety of classifications. Eradication of cancer cells in both breast and lymph nodes has been better associated with improved prognosis than in the breast alone. Even in patients diagnosed as having clinically node-negative cancer before NAC, postoperative pathological examination often shows axillary lymph node metastases.

Patients and Methods

Of the 771 patients with breast cancer who underwent NAC in the Cancer Institute Hospital between January 2000 and May 2009, 146 patients preoperatively diagnosed as having node-negative breast cancer were retrospectively evaluated. We have made the definition of clinically lymph node-negative N0 as follows: first, ultrasonography before NAC did not show any lymphadenopathy. Second, a cytological procedure confirmed negative study for each patient when ultrasonography suggested lymphadenopathy.

Results

The median observation period was 79.7 months, and the median age of the subjects was 51 years. Pathological examination at the time of the surgery showed lymph node metastases ypN+ in 46 patients 31.5%. Histological therapeutic effects revealed ypT0-is in 9 patients 6.2% and ypTinv in 137 93.8%. Multivariate analysis demonstrated that younger age 49>, large tumor size, NG3, and ypN+ were significant poor prognostic factors for DFS p = 0.020, p = 0.008, P = 0.022 and p = 0.010, respectively. Moreover, ypN+ was the only significant poor prognostic factor for OS p = 0.022. The predictive factors of ypN+ in clinically lymph node–negative breast cancer were ypTinv p = 0.036 and the luminal type HR+ and HER2- p = 0.029.

Conclusion

The prognosis of clinically lymph node negative breast cancer depended on ypN+, which was associated with ypTinv and luminal subtype.



Autor: Ippei Fukada , Kazuhiro Araki, Kokoro Kobayashi, Tomoko Shibayama, Shunji Takahashi, Rie Horii, Futoshi Akiyama, Takuji Iwase, Sh

Fuente: http://plos.srce.hr/



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