ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Evaluating total tumor load (TTL) to predict metastasis in four or more axillary lymph nodes in HR +/HER2- breast cancer patients: the TULIP4N + study.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo validate the predictive value of Total Tumor Load (TTL), based on Cytokeratin 19 (CK19) mRNA copy number measured by OSNA in sentinel lymph nodes (SLNs), and to establish an optimal cut-off for identifying HR + /HER2- breast cancer (BC) patients at high risk of ≥ 4 metastatic lymph nodes (LNs), eligible for adjuvant abemaciclib therapy. PATIENTS/
methodsA retrospective, international, multicenter study pooling data from six studies conducted between 2000 and 2016 in adult BC patients with SLN biopsies analyzed by OSNA. Variables were TTL (CK19 mRNA copies/µL) in SLNs, number of LNs removed, and number of metastatic ones. We constructed receiver operating characteristics (ROC) curves to determine optimal TTL values and multivariate logistic regression models to identify relevant prognostic factors for predicting ≥ 4 LN metastases.
resultsWe included 3804 patients with HR + /HER2- tumors of any histological type, complete axillary LN dissection, and > 4 LNs removed; 608 (16.0%) had ≥ 4 metastatic LNs and 439 had lobular BC. At cut-offs of 99,500 and 101,000 copies/µL, TTL had a 32.3% and 32.4% PPV. In lobular BC, cut-offs between 92,305 and 108,700 copies/µL reached a 40% PPV. In lobular HR + /HER2- BC, a multivariate model including tumor grade, TTL, and lymphovascular invasion reached a 49% PPV for predicting ≥ 4 metastatic LNs, yielding a nomogram and an online calculator for use in routine practice.
conclusionTTL measured using OSNA predicts ≥ 4 metastatic LNs in patients with luminal-like BC, with a proposed optimal threshold of 100,000 copies/µL.
trial registrationNot applicable.
Indexed as
Identifiers
42250186What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.