Predictors of Nodal Pathologic Complete Response After Neoadjuvant Chemotherapy in Breast Cancer

Area of Science:

• Oncology
• Breast Cancer Research
• Clinical Trial Analysis

Background:

• Nodal pathologic complete response (npCR) after neoadjuvant treatment for node-positive breast cancer (BC) can help patients avoid axillary dissection.
• Identifying predictors of npCR is crucial for optimizing treatment strategies and patient outcomes.

Purpose of the Study:

• To identify predictors of nodal pathologic complete response (npCR) in patients with stage 2-3 breast cancer and clinically positive nodes.
• To analyze the association of sociodemographic factors, tumor characteristics, and treatment with npCR.

Main Methods:

• Utilized data from the National Cancer Database (2011-2021) including adult women with stage 2-3 BC and clinically positive nodes.
• Included patients who received neoadjuvant chemotherapy followed by surgery within 8 months.
• Modeled predictors of npCR using multivariable logistic regression analysis.

Main Results:

• Out of 47,483 patients, 40.0% achieved npCR.
• Younger age (OR 0.99), ER-/HER2+ subtype (OR 1.32 vs. TNBC), and immunotherapy (OR 1.60) were associated with higher npCR.
• Black patients had lower overall npCR (OR 0.90), with subtype-specific variations.

Conclusions:

• Both tumor biology and sociodemographic factors significantly influence npCR in breast cancer patients.
• Racial disparities in npCR exist, with Black patients showing differential response rates based on ER+/HER2- and hormone receptor-negative/HER2+ subtypes.
• Further investigation into the mechanisms behind these racial differences in npCR is warranted.