Sentinel Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer: Real Life Results
DOI:
https://doi.org/10.32635/2176-9745.RBC.2024v70n3.4683Palavras-chave:
Tratamento Farmacológico, Neoplasias da Mama/cirurgia, Excisão de Linfonodo, Biópsia de Linfonodo Sentinela, DemografiaResumo
Introdução: O câncer de mama (CM) é o mais comum entre as mulheres. A quimioterapia neoadjuvante (QTNEO) visa melhorar as condições cirúrgicas em pacientes com CM localmente avançado. Objetivo: Comparar as características demográficas, clínicas e de tratamento de mulheres submetidas à QTNEO para tratamento de CM de acordo com a linfadenectomia axilar (LA) ou biópsia de linfonodo sentinela (BLS) e analisar os fatores associados à indicação de BLS em um cenário da vida real. Método: Estudo de coorte retrospectivo em mulheres com CM e indicação de QTNEO. Foram obtidas variáveis demográficas, clínicas, tumorais e de tratamento. Foi realizada regressão logística simples e múltipla para avaliar os fatores independentes associados à indicação de BLS. Resultados: Foram incluídas 918 pacientes, das quais 17,5% foram submetidas à BLS e 11,4% à BLS seguida de LA. As mulheres em estádio III tiveram 95% menos probabilidade de serem submetidas à BLS (OR = 0,05; IC 95%: 0,01-0,17; p < 0,001) em comparação com aquelas no estádio I. As submetidas à mastectomia apresentaram 90% menor chance de realizar BLS do que aquelas com cirurgia conservadora (IC95%: 0,06-0,17; p < 0,001). Considerando as respostas da QTNEO, os casos sem resposta ou com progressão da doença apresentaram chance 55% menor de serem submetidos à BLS em comparação às que apresentaram resposta total (OR = 0,45; IC 95%: 0,24-0,82; p = 0,009). Conclusão: A BLS foi realizada em 29% das pacientes após QTNEO. Pacientes que apresentavam estágio clínico mais avançado da doença e pior resposta à QTNEO e as que foram submetidas a mastectomias tiveram menor probabilidade de serem submetidas à BLS.
Downloads
Referências
Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi: https://doi.org/10.3322/caac.21834 DOI: https://doi.org/10.3322/caac.21834
Santos MO, Lima FCS, Martins LFL, et al. Estimativa de incidência de câncer no Brasil, 2023-2025. Rev Bras Cancerol. 2023;69(1):e-213700. https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700 DOI: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700
Mano MS. Neoadjuvant chemotherapy in breast cancer: time for an appraisal. Mastology. 2018;28(3):131-3. doi: https://doi.org/10.29289/259453942018EDIT283 DOI: https://doi.org/10.29289/259453942018EDIT283
Woodward SG, Fayanju OM. Optimizing sentinel node biopsy after neoadjuvant therapy: striving to know what we do not know. Ann Surg Oncol. 2023;30(4):1943-4. doi: https://doi.org/10.1245/s10434-022-12942-x DOI: https://doi.org/10.1245/s10434-022-12942-x
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: metaanalysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27-39. doi: https://doi.org/10.1016/S1470-2045(17)30777-5 DOI: https://doi.org/10.1016/S1470-2045(17)30777-5
Lee SB, Yu JH, Park H, et al. Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer with axillary node metastasis: a survey of clinical practice. Asian J Surg. 2019;42(1):314-9. doi: https://doi.org/10.1016/j.asjsur.2018.06.004 DOI: https://doi.org/10.1016/j.asjsur.2018.06.004
Magnoni F, Galimberti V, Corso G, et al. Axillary surgery in breast cancer: an updated historical perspective. Semin Oncol. 2020;47(6):341-52. doi: https://doi.org/10.1053/j.seminoncol.2020.09.001 DOI: https://doi.org/10.1053/j.seminoncol.2020.09.001
Wazir U, Mokbel K. De-escalation of axillary surgery in the neoadjuvant chemotherapy (NACT) setting for breast cancer: is it oncologically safe? Anticancer Res. 2020;40(10):5351-4. doi: https://doi.org/10.21873/anticanres.14542 DOI: https://doi.org/10.21873/anticanres.14542
Vázquez JC, Piñero A, Castro FJ, et al. The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview. Clin Transl Oncol. 2022;24(9):1744-54. doi: https://doi.org/10.1007/s12094-022-02824-9 DOI: https://doi.org/10.1007/s12094-022-02824-9
Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven nodepositive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258-64. doi: https://doi.org/10.1200/jco.2014.55.7827 DOI: https://doi.org/10.1200/JCO.2014.55.7827
Lin SQ, Vo NP, Yen YC, et al. Outcomes of sentinel node biopsy for women with breast cancer after neoadjuvant therapy: systematic review and meta-analysis of realworld data. Ann Surg Oncol. 2022;29(5):3038-49. doi: https://doi.org/10.1245/s10434-021-11297-z DOI: https://doi.org/10.1245/s10434-021-11297-z
Gandhi A, Coles C, Makris A, et al. Axillary surgery following neoadjuvant chemotherapy - multidisciplinary guidance from the Association of Breast Surgery, Faculty of Clinical Oncology of the Royal College of Radiologists, UK Breast Cancer Group, National Coordinating Committee for Breast Pathology and British Society of Breast Radiology. Clin Oncol (R Coll Radiol). 2019;31(9):664-8. doi: https://doi.org/10.1016/j.clon.2019.05.021 DOI: https://doi.org/10.1016/j.clon.2019.05.021
Vázquez JC, Piñero A, Castro FJ, et al. The value of sentinel lymph-node biopsy in women with nodepositive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review. Clin Transl Oncol. 2023;25(2):417-28. doi: https://doi.org/10.1007/s12094-022-02953-1 DOI: https://doi.org/10.1007/s12094-022-02953-1
SPSS®: Statistical Package for Social Science (SPSS) [Internet]. Versão 23.0. [Nova York]. International Business Machines Corporation. [acesso 2023 mar 9]. Disponível em: https://www.ibm.com/br-pt/spss?utm_content=SRCWW&p1=Search&p4=43700077515785492&p5=p&gclid=CjwKCAjwgZCoBhBnEiwAz35Rwiltb7s14pOSLocnooMOQh9qAL59IHVc9WP4ixhNTVMjenRp3-aEgxoCubsQAvD_BwE&gclsrc=aw.ds
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.
Rosenberger LH, Ren Y, Thomas SM, et al. Axillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough? Breast Cancer Res Treat. 2020;179(3):661-70. doi: https://doi.org/10.1007/s10549-019-05500-9 DOI: https://doi.org/10.1007/s10549-019-05500-9
Srour MK, Tseng J, Luu M, et al. Patterns in the use of axillary operations for patients with node-positive breast cancer after neoadjuvant chemotherapy: a National Cancer Database (NCDB) analysis. Ann Surg Oncol. 2019;26(10):3305-11. doi: https://doi.org/10.1245/s10434-019-07540-3 DOI: https://doi.org/10.1245/s10434-019-07540-3
Amendola LCB, Gaui MFD, Carneiro AHPC, et al. Clinicopathologic profile of breast cancer patients treated with neoadjuvant chemotherapy at HUCFF/UFRJ. Mastology. 2021;31:e20200076. https://doi.org/10.29289/2594539420200076 DOI: https://doi.org/10.29289/2594539420200076
Rocha-Brischiliari SC, Andrade L, Nihei OK, et al. Spatial distribution of breast cancer mortality: Socioeconomic disparities and access to treatment in the state of Parana, Brazil. PLoS One. 2018;13(10):e0205253. doi: https://doi.org/10.1371/journal.pone.0205253 DOI: https://doi.org/10.1371/journal.pone.0205253
Renna Junior NL, Silva G. Late-Stage diagnosis of breast cancer in brazil: analysis of data from hospital-based cancer registries (2000-2012). Rev Bras Ginecol Obstet. 2018;40(3):127-36. doi: https://doi.org/10.1055/s-0038-1624580 DOI: https://doi.org/10.1055/s-0038-1624580
Ko NY, Hong S, Winn RA, et al. Association of insurance status and racial disparities with the detection of earlystage breast cancer. JAMA Oncol. 2020;6(3):385-92. doi: https://doi.org/10.1001/jamaoncol.2019.5672 DOI: https://doi.org/10.1001/jamaoncol.2019.5672
Mets EJ, Chouairi FK, Gabrick KS, et al. Persistent disparities in breast cancer surgical outcomes among hispanic and African American patients. Eur J Surg Oncol. 2019;45(4):584-90. doi: https://doi.org/10.1016/j.ejso.2019.01.016 DOI: https://doi.org/10.1016/j.ejso.2019.01.016
Hardy D, Du DY. Socioeconomic and racial disparities in cancer stage at diagnosis, tumor size, and clinical outcomes in a large cohort of women with breast cancer, 2007-2016. J Racial Ethn Health Disparities. 2021;8(4):990-1001. doi: https://doi.org/10.1007/s40615-020-00855-y DOI: https://doi.org/10.1007/s40615-020-00855-y
Cintra JRD, Teixeira MTB, Diniz RW, et al. Perfil imunohistoquímico e variáveis clinicopatológicas no câncer de mama. Rev Assoc Med Bras. 2012;58(2):178-87. doi: https://doi.org/10.1590/S0104-42302012000200013 DOI: https://doi.org/10.1590/S0104-42302012000200013
Soares ICS, Bello MA, Bergmann A, et al. Comparison of the performance of four staging systems in determining the prognosis of breast cancer among women undergoing neoadjuvant chemotherapy. Breast Cancer Res Treat. 2021;187(2):547-55. doi: https://doi.org/10.1007/s10549-020-06077-4 DOI: https://doi.org/10.1007/s10549-020-06077-4
Carvalho FM, Bacchi LM, Pincerato KM, et al. Geographic differences in the distribution of molecular subtypes of breast cancer in Brazil. BMC Womens Health. 2014;14:102. doi: https://doi.org/10.1186/1472-6874-14-102 DOI: https://doi.org/10.1186/1472-6874-14-102
Blanco Sánchez A, Yébenes L, Berjón A, et al. Evaluación de la respuesta patológica a quimioterapia neoadyuvante en cáncer de mama: correlación con el fenotipo molecular. Rev Esp Patol. 2021;54(1):8-16. doi: https://doi.org/10.1016/j.patol.2020.07.003 DOI: https://doi.org/10.1016/j.patol.2020.07.003
Kunnuru SKR, Thiyagarajan M, Martin Daniel J, et al. a study on clinical and pathological responses to neoadjuvant chemotherapy in breast carcinoma. Breast Cancer (Dove Med Press). 2020;12:259-66. doi: https://doi.org/10.2147/BCTT.S277588 DOI: https://doi.org/10.2147/BCTT.S277588
Enokido K, Watanabe C, Nakamura S, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with an initial diagnosis of cytology-proven lymph node-positive breast cancer. Clin Breast Cancer. 2016;16(4):299-304. doi: https://doi.org/10.1016/j.clbc.2016.02.009 DOI: https://doi.org/10.1016/j.clbc.2016.02.009
Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918-26. doi: https://doi.org/10.1001/jama.2017.11470 DOI: https://doi.org/10.1001/jama.2017.11470
Galimberti V, Ribeiro Fontana SK, Maisonneuve P, et al. Sentinel node biopsy after neoadjuvant treatment in breast cancer: five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. Eur J Surg Oncol. 2016;42(3):361-8. doi: https://doi.org/10.1016/j.ejso.2015.11.019 DOI: https://doi.org/10.1016/j.ejso.2015.11.019
Caudle AS, Kuerer HM, Krishnamurthy S, et al. Feasibility of fine-needle aspiration for assessing responses to chemotherapy in metastatic nodes marked with clips in breast cancer: a prospective registry study. Cancer. 2019;125(3):365-73. doi: https://doi.org/10.1002/cncr.31825 DOI: https://doi.org/10.1002/cncr.31825
Moo TA, Edelweiss M, Hajiyeva S, et al. Is lowvolume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection? Ann Surg Oncol. 2018;25(6):1488-94. doi: https://doi.org/10.1245/s10434-018-6429-2 DOI: https://doi.org/10.1245/s10434-018-6429-2
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
