Citations 1
Nodal Burden and Oncologic Outcomes in Patients With Residual Isolated Tumor Cells After Neoadjuvant Chemotherapy (ypN0i+): The OPBC-05/ICARO Study
Montagna, Giacomo , Laws, Alison , Ferrucci, Massimo , Mrdutt, Mary M., Sun, Susie X. , Bademler, Süleyman , Balbaloĝlu, Hakan , Balint‐Lahat, Nora, Banys-Paluchowski, Maggie, Barrio, Andrea V. , Benson, John R. , Beşe, Nuran , Boyle, Marissa K. , Diego, Emilia J. , Eden, Claire , Eller, Ruth S. , Goldschmidt, Maite, Hlavin, Callie , Heidinger, Martin , Jelinska, Justyna, Çakmak, Güldeniz Karadeniz , King, Tari A. , Kuerer, Henry M. , Loesch, Julie M, Milardi, Francesco , Murawa, Dawid , Moo, Tracy‐Ann , Menes, Tehillah S. , Passeri, Daniele , Pastoriza, Jessica , Perhavec, Andraž , Pislar, Nina , Polidorio, Natália , Rami, Avina , Ryu, Jai Min , Schulz, Alexandra , Sevilimedu, Varadan , Uğurlu, Mustafa Ümit , Uras, Cihan, Hemert, Annemiek K. E. van , Wong, Stephanie M. , Yoo, Tae-Kyung , Zhang, Jennifer Q. , Cabıoğlu, Neslihan , Peeters, Marie-Jeanne T. F. D. Vrancken , Morrow, Monica , Weber, William P. , Group, on behalf of the ICARO Study, Andreozzi, Mariacarla, Barbalho, Daniel Meirelles , Boileau, J.-F., Brogi, Edi , Cabero, Flávia Vidal, Cocco, Daniela , Bree, Eelco de , Vernet-Tomás, M. , Deutschmann, Christine , Ditsch, Nina, Fick, Franziska, Fitzal, Florian , Flanagan, Meghan R. , Gentile, Damiano , Grabenstetter, Anne , Heil, Jörg, Holtschmidt, Johannes , Krawczyk, Natalia , Kühn, Thorsten, Kümmel, Sherko, Muslumanoglu, Mahmut , Nekljudova, Valentina , Newman, Lisa A. , Poulakaki, Fiorita , Schwartz, Christopher J. , Siegel, Emily , Simonson, Colin , Tampaki, Ekaterini Christina , Tampakis, Athanasios , Tausch, Christoph, Bruele, Astrid Botty van den , Vorburger, Denise , Weiss, Anna, Wimmer, Kerstin , Woodward, Steven G. , Ziauddin, Firdos M., Boughey, JC , Boyle, Marissa K , Eller, Ruth , Heidinger, Martin , Karadeniz Cakmak, Güldeniz , Kesmodel, Susan B , King, Tari A , Milardi, Francesco , Murawa, Dawid , Menes, Tehillah S , Passeri, Daniele , Pastoriza, Jessica M , Perhavec, Andraz , Polidorio, Natália , Rami, Avina , Ugurlu, M Umit , van Hemert, Annemiek , Yoo, Tae-Kyung Robyn , Zhang, Jennifer Q , Peeters, Marie-Jeanne Vrancken , Morrow, Monica , Weber, Walter P , Wong, Stephanie M , Mrdutt, Mary M , Banys‐Paluchowski, Maggie , Boughey, Judy C. , Uras, Cihan , Karanlık, Hasan , Group, on behalf of the ICARO Study, Ahn, Sung Gwe , Corsi, Fabio , Crown, Angelena , Esposito, Emanuela , Fayanju, Oluwadamilola M. , Gentilini, Oreste D , Gülçelik, Mehmet Ali , Heil, Joerg , Leo, Cornelia , Pilewskie, Melissa , Riedel, Fabian , Rocco, Nicola , Schnabel, Freya Ruth , Singer, Christian F. , Soares, Leonardo Ribeiro , Tasoulis, Marios Konstantinos , Urban, Cicero A. , Vergauwen, Glenn , Wärnberg, Fredrik , Williams, Austin David
Journal of Clinical Oncology | November 7, 2024 | Volume: 43 | Issue: 7 | Pages: 810-820
PURPOSE The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in patients with ypN0i+ treated with and without ALND. METHODS The Oncoplastic Breast Consortium-05/ICARO cohort study (ClinicalTrials.gov identifier: NCT06464341 ) retrospectively analyzed data from patients with stage I to III breast cancer with ITCs in SLNs after NAC from 62 centers in 18 countries. The primary end point was the 3-year rate of any axillary recurrence. The rate of any invasive recurrence was the secondary end point. RESULTS In total, 583 patients were included, of whom 182 (31%) had completion ALND and 401 (69%) did not. The median age was 48 years. Most patients (74%) were clinically node-positive at diagnosis and 41% had hormone receptor–positive/human epidermal growth factor receptor 2–negative tumors. The mean number of SLNs with ITCs was 1.2. Patients treated with ALND were more likely to present with cN2/3 disease (17% v 7%, P < .001), have ITCs detected on frozen section (62% v 8%, P < .001), have lymphovascular invasion (38% v 24%, P < .001), and receive adjuvant chest wall (89% v 78%, P = .024) and nodal radiation (82% v 75%, P = .038). Additional positive nodes were found at ALND in 30% of patients, but only 5% had macrometastases. The 3-year rates of any axillary and any invasive recurrence were 2% (95% CI, 0.95 to 3.6) and 11% (95% CI, 8 to 14), respectively, with no statistical difference by type of axillary surgery. CONCLUSION The nodal burden in patients with ypN0(i+) was low, and axillary recurrence after ALND omission was rare in patients selected for this approach. These results do not support routine ALND in all patients with ypN0(i+).