| Description |
- Background: The utility of sentinel lymph node biopsy (SLNB) in older patients remains controversial. Advancements in HER2-directed therapy have revolutionized disease response rates and prognosis, supporting efforts to reevaluate the utility of SLNB. We aimed to assess the differences in treatment and overall survival (OS) in older patients with HER2-positive breast cancer based on SLNB.
Methods: Using the National Cancer Database (2010-2020), patients >70y diagnosed with cT1- 2/cN0/M0, HER2-positive breast cancer were identified. Logistic regression assessed associations with SLNB, systemic therapy, and radiation. Cox proportional hazards models were used to identify factors associated with OS. Analyses were stratified by treatment sequence: 1) upfront surgery, or 2) neoadjuvant therapy (NAT) followed by surgery.
Results: Of the 17,609 patients included, 94% underwent upfront surgery (n=16,492), and the remaining had NAT (n=1,117). Those who underwent SLNB were more likely to receive adjuvant therapy, irrespective of nodal status [upfront surgery/systemic therapy (OR 2.82; 95% CI, 2.17-3.67); upfront surgery/radiation (OR, 3.97; 95% CI, 3.03-5.21); NAT/radiation (OR, 5.69; 95% CI, 1.83-17.69)]. Breast pCR rate was highest among the HR-negative/HER2-positive subtype (50.0%), of which none were found to be ypN+. Comorbidity burden was associated with significantly lower rates of adjuvant systemic therapy and worse OS.
Conclusions: Patients who underwent SLNB, regardless of pN status, were more likely to receive adjuvant therapy. Nodal positivity is exceedingly rare for patients with a breast pCR following NAT, especially among the HR-negative/HER2-postitive subtype. It is reasonable to consider omission of SLNB in select subgroups of older patients with HER2-positive breast cancer.
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