Axillary Management Following Neoadjuvant Chemotherapy in Clinically Node-Positive Breast Cancer.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Neoadjuvant chemotherapy (NCT) followed by axillary lymph node dissection (ALND) is a standard treatment for node-positive breast cancer.
• Omitting ALND is feasible for select patients achieving pathological complete response (pCR) after NCT, potentially reducing morbidity.
• Translating clinical trial findings on axillary de-escalation to real-world practice requires further investigation.

Purpose of the Study:

• To assess axillary management outcomes in a national cohort of patients with clinically node-positive breast cancer.
• To identify patient subgroups who may benefit from axillary de-escalation after NCT.
• To inform best practices for reducing morbidity through tailored axillary treatment.

Main Methods:

• Utilized the National Cancer Data Base (NCDB) for patient data from 2012-2020.
• Included women diagnosed with clinically node-positive invasive breast cancer receiving NCT and subsequent ALND.
• Statistically analyzed associations between clinicopathologic factors and axillary pCR.

Main Results:

• Out of 59,791 patients, 14.76% achieved nodal pCR.
• Patients with HR-negative/HER2-positive status were more likely to undergo ALND.
• Older patients (>70), those with insurance, and ypT1/ypT2 disease were less likely to undergo ALND.

Conclusions:

• A significant subset of patients with node-positive breast cancer underwent ALND despite achieving axillary pCR post-NCT.
• There is a clear opportunity to improve precision in selecting patients for axillary de-escalation.
• Enhanced precision can reduce treatment morbidity and personalize care for breast cancer patients.