Local regional management of the axilla after positive sentinel node biopsy in breast cancer patients clinically downstaged with neoadjuvant therapy: A population-based, real-world analysis.
Notice bibliographique
Résumé
e12578 Background: The optimal local regional management of the positive axilla in patients who convert to clinical negative nodal status after neoadjuvant chemotherapy (NAC) remains unclear. Specifically, the benefit of completion axillary node dissection (cALND) remains in question, particularly given the associated morbidity. With results of the A11202 trial pending, we noted regional variation in the management of the axilla in this population. We therefore aimed to describe the current management of women with positive SNB after NAC, describe recurrence patterns and identify predictors of cALND in a large, population-based, real-world setting. Methods: We identified all patients who had biopsy-proven nodal disease on presentation, underwent NAC and were then clinically downstaged allowing SNB as part of their index surgery from our Synoptec provincial operative database, from January 2016 to September 2021. Pre and post NAC tumour characteristics, patient demographics, treatments and final pathology were abstracted and conveyed using descriptive statistics. Primary outcome measures were treatment with cALND and recurrence. A Cox regression model was utilized to determine predictors of both outcomes. Results: A total of 850 patients had biopsy-proven axillary disease at presentation and subsequently underwent NAC. Of these, 364 patients converted to clinically-negative node status and had a SNB, of which 175 (48%) had persistent nodal disease. Median age of this group was 50 (IQR 43-60) and 143 patients (81.7%) were treated by a high-volume breast surgeon. Most patients had clinical T1/2 tumours (73.1%) before NAC, of which 21.1% were HER2 positive, and 12.6% were triple-negative. Post NAC, 95 patients (54.3%) underwent mastectomy. A total of 39/175 patients (22.3%) underwent a cALND. Median number of sentinel nodes was 4 (IQR 3, 5); the proportion of positive sentinel nodes did not differ in those who had cALND (0.59 vs. 0.59, p = 0.95). Almost all patients (96.6%) had regional radiation. After a median of 17 months of follow-up, 33 (18.8%) SNB positive patients recurred; the majority (29 (87.9%)) had a distant recurrence, 3 (9.1%) had an isolated local breast/chest wall recurrence, and only 1 (3.0%) had an isolated regional recurrence. As far as local control, in patients with any regional recurrence, 4/7 (57.1%) had undergone cALND. Treatment site was the only significant predictor of cALND on multivariable analysis. Predictors of recurrence were low BMI, triple-negative status and clinical T3/4 disease before NAC. Conclusions: The lack of definitive data for patients with persistent pathologic nodal disease after NAC has led to variable practice patterns, with lower than expected rates of cALND. Within our cohort, there was not a significant association between omission of cALND and regional recurrence.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».