Abstract
Background
The purpose of this study is to evaluate preoperative predictors of nodal metastases
in patients with early-stage, HER2-positive (HER2+) breast cancer.
Methods
The SEER Database was queried to identify women with a first diagnosis of stage I-II
(T1-T2) HER2-positive breast cancer treated with upfront surgery in 2018. Multivariable
logistic regression was used to identify clinical characteristics independently associated
with nodal involvement.
Results
Overall, 3333 women with stage I-II HER2+ breast cancer met inclusion criteria and
were included in the study. The median age at diagnosis was 59 years (IQR, 51–69 years).
Most patients underwent breast-conserving surgery (60.9%), with a median of 3 (IQR
2–4) axillary lymph nodes removed. On final pathology, 762 (22.9%) of T1-T2 HER2+
patients were node positive; 2.7% pN0[i+], 3.7% pN1mi, 15.1% pN1, and 1.4% pN2. Women
less than 40 years and those between 40 and 49 years showed the highest proportion
of axillary lymph node metastasis, in 33.7% and 30.7% respectively, and declining
with age (p < 0.001). Patients with triple-positive breast cancer had the highest
rates of nodal involvement (24.8%), compared to 20.7% ER+/PR-/HER2+ and 19.6% of HER2-enriched
patients (p = 0.006). On adjusted analysis, age, biologic subtype, tumour size, and
type of surgery remained independent predictors of nodal involvement. On subgroup
analysis, women under age 50 with T1c HER2-enriched or triple-positive breast cancer
had a 33% and 35% incidence of nodal involvement, which declined with age.
Conclusions
The likelihood of pathologic nodal involvement in early-stage HER2+ breast cancer
is contingent on age, ER/PR status, and tumour size.
Keywords
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Article info
Publication history
Published online: March 31, 2023
Accepted:
March 23,
2023
Received in revised form:
March 6,
2023
Received:
November 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd.
