Nodal Response After Neoadjuvant Chemotherapy and Potential Targets for Axillary Surgery De-Escalation in Breast Cancer Patients

Authors

  • Beatriz Pereira Gonçalves Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal https://orcid.org/0000-0001-6836-6154
  • Beatriz Costeira Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal https://orcid.org/0000-0001-5934-6792
  • Maria do Carmo Girão Department of General Surgery, Unidade Local de Saúde Baixo Alentejo, Beja, Portugal
  • Rodrigo Oom Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal https://orcid.org/0000-0002-5365-9410
  • Cristina Sousa Costa Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal
  • João Vargas Moniz Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal
  • Nuno Abecasis Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal https://orcid.org/0000-0002-5904-6244
  • Catarina Rodrigues dos Santos Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal https://orcid.org/0000-0002-8079-8053

DOI:

https://doi.org/10.34635/rpc.1106

Keywords:

Breast Neoplasms/surgery, Lymph Node Excision, Lymph Nodes, Neoadjuvant Therapy, Sentinel Lymph Node Biopsy

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) has the potential for tumor downstaging and surgery de-escalation. In the axilla, this approach is less established, especially in cN+→ycN0. Targeted axillary dissection is an option, but difficult to concretize. We aim to identify biological factors associated with nodal pathological complete response (pCR) and recognize potential candidates for a more conservative axillary approach after NAC, such as sentinel lymph node biopsy (SLNB).
Methods: Retrospective, single-center cohort of patients with node-positive breast cancer, treated with NAC followed by axillary lymph node dissection from 2017 to 2021. The primary outcome was nodal pCR, overall and by molecular subtypes. A logistic regression model was conducted to identify biological factors predicting nodal pCR.
Results: A total of 414 patients were included. Overall, the nodal pCR rate was 37.9%. It was higher in HR+/HER2+ (62.1%), HR-/HER2+ (61.0%) and HR-/HER2- (56.3%) tumors, whereas only 21.6% in HR+/HER2- (p<0.001). In patients without nodal pCR, HR+/HER2- had the highest median number of positive lymph nodes (p=0.038). In multivariate analysis, HR+/HER2+ (OR 5.157, 95% CI 2.768-9.608, p<0.001), HR-/HER2+ (OR 4.207, 95% CI 1.935-9.147, p<0.001), HR-/HER2- (OR 2.242, 95% CI 1.180-4.261, p=0.014), and differentiation grade 3 (OR 4.075, 95% CI 2.448-6.784, p<0.001) were independently associated with nodal pCR.
Conclusion: Our data reveal HER2+, triple-negative and grade 3 tumors as predictive factors for nodal pCR. Parallel to the breast, axillary surgery de-escalation may be guided by tumor intrinsic factors. Identifying these “good responders” could help identify the candidates for a simpler axillary approach after NAC, such as SLNB.

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Published

2025-09-11

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