Residuale axilläre Metastasenlast nach neoadjuvanter Chemotherapie (NACT) bei Patientinnen mit Mammakarzinom im Frühstadium und a priori klinisch okkulten Lymphknotenmetastasen – eine transSENTINA-Analyse

Zusammenfassung

Hintergrund Der Zusammenhang zwischen pathologischer Komplettremission (pCR) der Brust und klinischen/pathologischen Parametern ist bei Brustkrebspatientinnen, die sich einer neoadjuvanten Chemotherapie (NACT) unterziehen, bekannt. Noch nicht geklärt ist aber der Zusammenhang zwischen diesen Parametern und der residualen axillären Lymphknotenlast nach NACT.

Methoden In dieser Studie wurden Patientinnen mit klinisch okkulten Lymphknotenmetastasen (d. h. klinisch negativ, aber SLN-positiv vor NACT; d. h. aus dem Arm B der SENTINA-Studie) aufgenommen. Bei allen Patientinnen wurden eine zweite Sentinel-Lymphknoten-Biopsie (SLNB) sowie eine axilläre Lymphknotendissektion nach NACT durchgeführt. Es wurden univariate und multivariate Analysen durchgeführt, um den Zusammenhang zwischen klinischen/pathologischen Parametern und axillärem Lymphknotenbefall nach NACT zu bestimmen.

Ergebnisse Es wurden 360 Patientinnen aus dem Arm B der SENTINA-Studie in diese Studie aufgenommen; die Daten von 318 dieser Patientinnen wurden analysiert. Nach der NACT wurde bei 71/318 (22,3 %) Patientinnen ein Befall der SLN oder Non-SLN festgestellt. Bei insgesamt 71/318 (22,3 %) Patientinnen konnte eine pCR der Brust erreicht werden. Der Zusammenhang zwischen extranodaler Ausbreitung, fehlender Multifokalität sowie pCR der Brust und der residualen axillären Lymphknotenlast war statistisch signifikant. Bei der deskriptiven Analyse aller Patientinnen mit klinisch negativen axillären Lymphknoten vor NACT in der SENTINA-Studie hatten 1,2 % der triplenegativen (TN) Patientinnen und 0,5 % der HER/2-positiven Patientinnen eine residuale axilläre Tumorlast trotz pCR der Brust.

Schlussfolgerung Patientinnen der SENTINA-Studie mit klinisch negativen axillären Lymphknoten und Sentinel-Lymphknoten-Befall haben ein signifikantes Risiko für nodale Metastasen nach NACT. Allerdings ist das Risiko einer residualen axillären Tumorlast besonders gering bei Frauen mit pathologischer Komplettremission der Brust und triplenegativen oder HER/2-positiven Tumoren.

Abstract

Background Among patients with breast cancer undergoing neoadjuvant chemotherapy (NACT), the association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the association between these parameters and residual axillary involvement after NACT remains unclear.

Methods Patients with clinically occult nodal metastases (i. e. negative by clinical assessment but positive by SLNB prior to NACT, i. e. Arm B of the SENTINA trial) were included in the presented analysis. All patients received a second sentinel lymph node biopsy (SLNB) and axillary dissection after NACT. Univariate and multivariate analyses were carried out to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.

Results Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable for this analysis. After NACT, 71/318 (22.3 %) patients had involved SLNs or non-SLNs after NACT. Overall, 71/318 (22.3 %) patients achieved a pCR in the breast. Associations of extranodal spread, lack of multifocality and pCR in the breast with residual axillary burden were statistically significant. In a descriptive analysis including all patients with clinically negative axilla before NACT in the SENTINA trial 1.2 % of triple negative (TN) patients and 0.5 % of HER/2 positive patients had residual axillary disease in case of a breast pCR.

Conclusions Patients in the SENTINA trial with clinically negative axilla and involved SLNs still carried a significant risk of nodal metastases after NACT. However, the risk of residual axillary burden was particularly low in TN and HER/2 positive tumors in case of a breast pCR.

Schlüsselwörter

prädiktiver Wert des Lymphknotenstatus - primäre Systemtherapie - SENTINA-Studie - Sentinel-Lymphknoten-Biopsie

Key words

prediction of lymph node status - primary systemic therapy - SENTINA trial - sentinel lymph node biopsy

Publikationsverlauf

Artikel online veröffentlicht:
30. September 2021

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