Positive Lymph Nodes Not a Reliable Indicator for Chemo in Some Women With Breast Cancer

NEW YORK (Reuters Health) – Sentinel node biopsy may not be helpful for adjuvant chemotherapy decisions in some older women with breast cancer, according to featured research presented at the American Society of Breast Surgeons annual meeting.

“Sentinel node biopsy has some associated morbidity and is an additional procedure in the operating room. However, it may not provide the necessary information for decision-making about adjuvant chemotherapy,” lead investigator Katharine Yao with University of Chicago said in a news release.

“For this patient population, consideration of other tumor factors including possibly an Oncotype score may be more useful than nodal status,” Dr. Yao added.

Dr. Yao and colleagues assessed the correlation between nodal status and the Oncotype Dx 21-gene recurrence score, which reflects a tumor’s individual biology and is widely used to aid decisions about adjuvant chemotherapy.

Using the National Cancer Database, they analyzed 28,338 women aged 70 and older who were treated for HR-positive, HER2-negative, AJCC clinical stage T1-T2 breast cancers between 2010 and 2018.

A total of 5,640 women (19.9%) were node positive and 22,698 (80.1%) were node negative.

Overall, the proportion of women with a 21-gene recurrence score of 26 or greater, which typically indicates that chemotherapy will be beneficial, was similar in node negative and node positive women (13.1% and 14.7%, respectively).

For both node negative and positive women, grade 3 tumors were associated most strongly with a high 21-gene recurrence score, followed by negative progesterone receptor status.

Additionally, women with tumors greater than 2 cm and those covered by Medicaid were also more likely to have a cancer recurrence score greater than or equal to 26.

Hispanic women were less likely to have a 21-gene recurrence score rendering them eligible for chemotherapy compared to Black and Asian women.

“Women may request sentinel node biopsies because cancer that has spread to the lymph nodes has become virtually synonymous with poor prognosis in the popular media,” Dr. Yao said in the release.

“However, we are learning that there is more to tumor biology than just nodal status. Sentinel node biopsy for women older than age 70 with hormone receptor positive breast cancer is not really helpful for making adjuvant chemotherapy decisions. While eliminating sentinel node biopsy may seem counter-intuitive to some patients, it is not likely to have a major impact on their outcomes,” Dr. Yao added.

The study had no commercial funding and the authors have declared no relevant disclosures.

SOURCE: https://bit.ly/3E8sQ9W American Society of Breast Surgeons annual meeting, held April 6-10, 2022.

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