Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy

Alison U. Barron, Tanya L. Hoskin, Judy C Boughey

Research output: Contribution to journalArticle

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Abstract

Background: The standard of care for breast cancer patients treated with neoadjuvant chemotherapy (NAC) who have a positive sentinel lymph node (+SLN) after NAC is completion axillary lymph node dissection (ALND). This study aimed to develop a nomogram to predict additional nodal disease in patients with +SLN after NAC. Methods: The study reviewed patients 18 years of age or older who had invasive breast cancer treated with NAC followed by SLN surgery with +SLN and ALND between 2006 and 2017 at the authors’ institution. Factors predictive of positive non-SLNs were analyzed using uni- and multivariable logistic regression. Results: The study identified 120 patients with +SLN after NAC and ALND. Of these patients, 30.8% were clinically node-negative (cN−), and 69.2% were clinically node-positive (cN+) before NAC. Tumor biology was human epidermal growth factor receptor 2-positive (HER2+) for 20%, hormone receptor-positive (HR+)/HER2− for 66.7%, and triple-negative breast cancer (TNBC) for 13.3% of the patients. Additional nodal disease was found on ALND for 63.3% of the patients. In the univariate analysis, the factors predictive of positive non-SLNs were biologic subtype (TNBC and HR+/HER2− vs HER2+; p < 0.001), higher grade (p = 0.047), higher pT category (p = 0.02), SLN extranodal extension (p = 0.03), larger SLN metastasis size (p < 0.001), and higher number of +SLNs (p = 0.02). The factors significant in the multivariable analysis included number of +SLNs, grade 3 vs grade 1 or 2, HER2+ versus HER2−, cN+ versus cN−, and larger SLN metastasis size. The resulting model showed excellent discrimination (area under the curve, 0.82; 95% confidence interval, 0.74–0.90) and good calibration (p = 0.54, Hosmer–Lemeshow). Conclusion: A clinical prediction model incorporating biologic subtype, grade, clinical node status, size of the largest SLN metastasis, and number of +SLNs can help physicians and patients estimate the likelihood of additional nodal disease and may be useful for guiding decision making regarding axillary management.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jun 28 2018

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Lymph Nodes
Neoplasm Metastasis
Drug Therapy
Lymph Node Excision
Triple Negative Breast Neoplasms
Breast Neoplasms
Biological Models
Nomograms
Sentinel Lymph Node
Standard of Care
Calibration
Area Under Curve
Decision Making
Logistic Models
Hormones
Confidence Intervals
Physicians
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy. / Barron, Alison U.; Hoskin, Tanya L.; Boughey, Judy C.

In: Annals of Surgical Oncology, 28.06.2018, p. 1-8.

Research output: Contribution to journalArticle

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title = "Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy",
abstract = "Background: The standard of care for breast cancer patients treated with neoadjuvant chemotherapy (NAC) who have a positive sentinel lymph node (+SLN) after NAC is completion axillary lymph node dissection (ALND). This study aimed to develop a nomogram to predict additional nodal disease in patients with +SLN after NAC. Methods: The study reviewed patients 18 years of age or older who had invasive breast cancer treated with NAC followed by SLN surgery with +SLN and ALND between 2006 and 2017 at the authors’ institution. Factors predictive of positive non-SLNs were analyzed using uni- and multivariable logistic regression. Results: The study identified 120 patients with +SLN after NAC and ALND. Of these patients, 30.8{\%} were clinically node-negative (cN−), and 69.2{\%} were clinically node-positive (cN+) before NAC. Tumor biology was human epidermal growth factor receptor 2-positive (HER2+) for 20{\%}, hormone receptor-positive (HR+)/HER2− for 66.7{\%}, and triple-negative breast cancer (TNBC) for 13.3{\%} of the patients. Additional nodal disease was found on ALND for 63.3{\%} of the patients. In the univariate analysis, the factors predictive of positive non-SLNs were biologic subtype (TNBC and HR+/HER2− vs HER2+; p < 0.001), higher grade (p = 0.047), higher pT category (p = 0.02), SLN extranodal extension (p = 0.03), larger SLN metastasis size (p < 0.001), and higher number of +SLNs (p = 0.02). The factors significant in the multivariable analysis included number of +SLNs, grade 3 vs grade 1 or 2, HER2+ versus HER2−, cN+ versus cN−, and larger SLN metastasis size. The resulting model showed excellent discrimination (area under the curve, 0.82; 95{\%} confidence interval, 0.74–0.90) and good calibration (p = 0.54, Hosmer–Lemeshow). Conclusion: A clinical prediction model incorporating biologic subtype, grade, clinical node status, size of the largest SLN metastasis, and number of +SLNs can help physicians and patients estimate the likelihood of additional nodal disease and may be useful for guiding decision making regarding axillary management.",
author = "Barron, {Alison U.} and Hoskin, {Tanya L.} and Boughey, {Judy C}",
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T1 - Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy

AU - Barron, Alison U.

AU - Hoskin, Tanya L.

AU - Boughey, Judy C

PY - 2018/6/28

Y1 - 2018/6/28

N2 - Background: The standard of care for breast cancer patients treated with neoadjuvant chemotherapy (NAC) who have a positive sentinel lymph node (+SLN) after NAC is completion axillary lymph node dissection (ALND). This study aimed to develop a nomogram to predict additional nodal disease in patients with +SLN after NAC. Methods: The study reviewed patients 18 years of age or older who had invasive breast cancer treated with NAC followed by SLN surgery with +SLN and ALND between 2006 and 2017 at the authors’ institution. Factors predictive of positive non-SLNs were analyzed using uni- and multivariable logistic regression. Results: The study identified 120 patients with +SLN after NAC and ALND. Of these patients, 30.8% were clinically node-negative (cN−), and 69.2% were clinically node-positive (cN+) before NAC. Tumor biology was human epidermal growth factor receptor 2-positive (HER2+) for 20%, hormone receptor-positive (HR+)/HER2− for 66.7%, and triple-negative breast cancer (TNBC) for 13.3% of the patients. Additional nodal disease was found on ALND for 63.3% of the patients. In the univariate analysis, the factors predictive of positive non-SLNs were biologic subtype (TNBC and HR+/HER2− vs HER2+; p < 0.001), higher grade (p = 0.047), higher pT category (p = 0.02), SLN extranodal extension (p = 0.03), larger SLN metastasis size (p < 0.001), and higher number of +SLNs (p = 0.02). The factors significant in the multivariable analysis included number of +SLNs, grade 3 vs grade 1 or 2, HER2+ versus HER2−, cN+ versus cN−, and larger SLN metastasis size. The resulting model showed excellent discrimination (area under the curve, 0.82; 95% confidence interval, 0.74–0.90) and good calibration (p = 0.54, Hosmer–Lemeshow). Conclusion: A clinical prediction model incorporating biologic subtype, grade, clinical node status, size of the largest SLN metastasis, and number of +SLNs can help physicians and patients estimate the likelihood of additional nodal disease and may be useful for guiding decision making regarding axillary management.

AB - Background: The standard of care for breast cancer patients treated with neoadjuvant chemotherapy (NAC) who have a positive sentinel lymph node (+SLN) after NAC is completion axillary lymph node dissection (ALND). This study aimed to develop a nomogram to predict additional nodal disease in patients with +SLN after NAC. Methods: The study reviewed patients 18 years of age or older who had invasive breast cancer treated with NAC followed by SLN surgery with +SLN and ALND between 2006 and 2017 at the authors’ institution. Factors predictive of positive non-SLNs were analyzed using uni- and multivariable logistic regression. Results: The study identified 120 patients with +SLN after NAC and ALND. Of these patients, 30.8% were clinically node-negative (cN−), and 69.2% were clinically node-positive (cN+) before NAC. Tumor biology was human epidermal growth factor receptor 2-positive (HER2+) for 20%, hormone receptor-positive (HR+)/HER2− for 66.7%, and triple-negative breast cancer (TNBC) for 13.3% of the patients. Additional nodal disease was found on ALND for 63.3% of the patients. In the univariate analysis, the factors predictive of positive non-SLNs were biologic subtype (TNBC and HR+/HER2− vs HER2+; p < 0.001), higher grade (p = 0.047), higher pT category (p = 0.02), SLN extranodal extension (p = 0.03), larger SLN metastasis size (p < 0.001), and higher number of +SLNs (p = 0.02). The factors significant in the multivariable analysis included number of +SLNs, grade 3 vs grade 1 or 2, HER2+ versus HER2−, cN+ versus cN−, and larger SLN metastasis size. The resulting model showed excellent discrimination (area under the curve, 0.82; 95% confidence interval, 0.74–0.90) and good calibration (p = 0.54, Hosmer–Lemeshow). Conclusion: A clinical prediction model incorporating biologic subtype, grade, clinical node status, size of the largest SLN metastasis, and number of +SLNs can help physicians and patients estimate the likelihood of additional nodal disease and may be useful for guiding decision making regarding axillary management.

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