Axillary nodal disease burden is not associated with an elevated 21-gene recurrence score in post-menopausal women presenting with a clinically negative axilla

Astrid Botty van den Bruele; Morgan A Paul; Samantha M Thomas; Sarah L Sammons; Maggie L DiNome; Jennifer K Plichta; Sydney M Record; Hannah Woriax; Akiko Chiba; Laura H Rosenberger; E Shelley Hwang

doi:10.1016/j.amjsurg.2024.02.005

Axillary nodal disease burden is not associated with an elevated 21-gene recurrence score in post-menopausal women presenting with a clinically negative axilla

Am J Surg. 2024 Feb 6:S0002-9610(24)00067-9. doi: 10.1016/j.amjsurg.2024.02.005. Online ahead of print.

Affiliations

¹ Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA. Electronic address: AB958@duke.edu.
² Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
³ Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA.
⁴ Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA.
⁵ Department of Surgery, Duke University, Durham, NC, USA; Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA.

PMID: 38350748
DOI: 10.1016/j.amjsurg.2024.02.005

Abstract

Background: The predictive and prognostic value of the recurrence score (RS) has emphasized the importance of tumor biology and has reduced the prognostic implications of limited nodal burden in post-menopausal women with HR+/HER2-invasive breast cancer (IBC). It is unclear whether routine axillary staging has a continued role in the management of small, clinically node negative (cN0) HR+/HER2- IBC. We sought to estimate the association of RS with pN stage.

Methods: Patients >50yo diagnosed with cN0, HR+/HER2- IBC (2015-2019) with an available RS were identified from the National Cancer Database. The clinicopathologic characteristics and rates of pN-stage (pN0, pN1, pN2/3) were compared for RS of ≤25 vs. >25.

Results: The median patient age was 64.1 (IQR 58-69) and the majority (75%) of tumors displayed ductal histology. Most (81.6%) were cT1 on presentation and pT1 (74.7%) on final pathology. There were 130,568 (86.2%) with a RS ≤ 25 and 20,879 (13.8%) with a RS > 25. On final pathology, 128,995 (85.2%) were pN0 and 21,991 (14.5%) pN1. Of the pN1, 2699 (12.3%) yielded a RS > 25. There were 461 (0.3%) patients with pN2-pN3 disease. Of those, 57 (12.4%) had RS > 25.

Conclusion: In our analysis, pN0 and pN1 tumors are biologically similar by gene expression assay in postmenopausal patients with similar proportions of high RS. These data support the notion that tumor biology examined via RS may have more prognostic and predictive value than metastatic dissemination to limited lymph nodes. These findings support the ongoing evaluation of routine axillary staging in postmenopausal patients with HR+/HER2- IBC.

Keywords: Axillary dissection; Breast cancer; Ductal cancer; Invasive breast cancer; Lobular cancer; Nodal burden; Oncotype score; Recurrence score; Sentinel lymph node.