Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China.

Rui Chen,Yan Li,Xiaofeng Huang,Qiannan Zhu,Jue Wang,Xiaoqing Shi,Lu Xu,Weiwei Zhang,Shuo Li,Yinggang Xu,Xiaoming Zha

doi:10.1007/s00432-021-03763-8

Abstract

Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 and ypTis subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown. This study was to evaluate the status of axillary lymph nodes for patients who achieved breast pCR after NST in the real-world study. This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR. The rate of breast pCR after NST was 27.1% (70/258). Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (100% vs. 85.7%, P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (82.7% vs. 22.9%, P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (94.3% vs. 58.8%, P = 0.0034). Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).

Highlights

Neoadjuvant systemic therapy (NST) is increasingly used in breast cancer treatment, for locally advanced disease and for operable cases
Among those with breast pathologic complete response (pCR), the rate of axillary pCR was 100% in both the ypT0 and in situ carcinoma in the breast (ypTis) subgroups. Among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (P < 0.0001)
Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (P = 0.0034)

Summary

Introduction

Neoadjuvant systemic therapy (NST) is increasingly used in breast cancer treatment, for locally advanced disease and for operable cases. In the WSG-ADAPT-TN trial, patients who achieved pCR after nanoparticle albumin-bound paclitaxel-based NST could skip postoperative anthracycline-containing chemotherapy for chemotherapy de-escalation[3]. Another aim is to de-escalate or omit surgery in patients with pCR. Results from a feasibility trial by the MD Anderson Cancer Center (MDACC) demonstrated a very high accuracy rate between extensive vacuum-assisted core biopsy/fineneedle aspiration biopsy and lumpectomy of the marked breast tumor bed after NST4, suggesting that breast surgery may be omitted in patients with documented breast pCR. Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). Whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown

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Results

Conclusion