ER-Poor and HER2-Positive: A Potential Subtype of Breast Cancer to Avoid Axillary Dissection in Node Positive Patients after Neoadjuvant Chemo-Trastuzumab Therapy

作者：Li, Jian-wei; Mo, Miao; Yu, Ke-da; Chen, Can-ming; Hu, Zhen; Hou, Yi-feng; Di, Gen-hong; Wu, Jiong; Shen, Zhen-zhou; Shao, Zhi-ming; Liu, Guang-yu^*

来源：PLos One, 2014, 9(12): e114646.

DOI：10.1371/journal.pone.0114646

• PATHOLOGICAL COMPLETE REMISSION
• OPEN-LABEL
• PREOPERATIVE CHEMOTHERAPY
• GUIDELINE RECOMMENDATIONS
• ADJUVANT BREAST
• SENTINEL
• BIOPSY
• TRIAL
• MULTICENTER
• PACLITAXEL

Purpose: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC) with or without trastuzumab in HER2-positive breast cancer. @@@ Methods: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA) before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m(2) and carboplatin AUC=2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m(2) and carboplatin AUC=6 every-3-week) and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week) or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB) before axillary dissection. @@@ Results: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B). After axillary dissection, the overall pathologically node negative rates (pNNR) were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with >= 4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ERpoor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection. @@@ Conclusions: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for accurate axillary evaluation after effective downstaging by neoadjuvant chemo-trastuzumab therapy.

• 出版日期2014-12-11
• 单位复旦大学