Abstract：
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.
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.
摘要：
背景：前哨淋巴结活检（SLNB）在老年患者中的应用仍存在争议。人类表皮生长因子受体2（HER2）靶向治疗的进展彻底改变了疾病的反应率和预后，支持重新评估SLNB效用的努力。我们旨在评估基于SLNB的老年HER2阳性乳腺癌患者在治疗和总生存期（OS）方面的差异。
方法：使用国家癌症数据库（2010-2020），诊断为cT1-2/cN0/M0,HER2阳性乳腺癌的≥70岁患者被鉴定.Logistic回归评估与SLNB的关联，全身治疗,和辐射。Cox比例风险模型用于确定与OS相关的因素。分析按治疗顺序分层，即前期手术或新辅助治疗（NAT），然后手术。
结果：在包括的17,609名患者中，94%接受了前期手术(n=16,492)，其余接受NAT(n=1117)。接受SLNB的患者更有可能接受辅助治疗，不考虑淋巴结状态{前期手术/全身治疗(比值比[OR]2.82,95%置信区间[CI]2.17-3.67);前期手术/放疗(OR3.97,95%CI3.03-5.21);NAT/放疗(OR5.69,95%CI1.83-17.69)}.乳腺病理完全缓解(pCR)率在激素受体(HR)阴性/HER2阳性亚型中最高(50.0%),其中没有一个被发现是ypN+。合并症负担与辅助系统治疗的比率显著降低和OS恶化相关。
结论：接受SLNB的患者，无论pN状态如何，更有可能接受辅助治疗。对于NAT后乳房pCR的患者，淋巴结阳性非常罕见，尤其是在HR阴性/HER2阳性亚型中。在选择的HER2阳性乳腺癌老年患者亚组中考虑省略SLNB是合理的。
方法：使用国家癌症数据库（2010-2020），诊断为cT1-2/cN0/M0,HER2阳性乳腺癌的≥70岁患者被鉴定.Logistic回归评估与SLNB的关联，全身治疗,和辐射。Cox比例风险模型用于确定与OS相关的因素。分析按治疗顺序分层，即前期手术或新辅助治疗（NAT），然后手术。
结果：在包括的17,609名患者中，94%接受了前期手术(n=16,492)，其余接受NAT(n=1117)。接受SLNB的患者更有可能接受辅助治疗，不考虑淋巴结状态{前期手术/全身治疗(比值比[OR]2.82,95%置信区间[CI]2.17-3.67);前期手术/放疗(OR3.97,95%CI3.03-5.21);NAT/放疗(OR5.69,95%CI1.83-17.69)}.乳腺病理完全缓解(pCR)率在激素受体(HR)阴性/HER2阳性亚型中最高(50.0%),其中没有一个被发现是ypN+。合并症负担与辅助系统治疗的比率显著降低和OS恶化相关。
结论：接受SLNB的患者，无论pN状态如何，更有可能接受辅助治疗。对于NAT后乳房pCR的患者，淋巴结阳性非常罕见，尤其是在HR阴性/HER2阳性亚型中。在选择的HER2阳性乳腺癌老年患者亚组中考虑省略SLNB是合理的。
