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

Nodal pathologic complete response (npCR) after neoadjuvant treatment in patients with node-positive breast cancer (BC) avoids the morbidity of axillary dissection. In this study, we aimed to identify predictors of npCR.

Adult women with stage 2-3 BC and clinically positive nodes from 2011 to 2021 in the National Cancer Database who received neoadjuvant chemotherapy followed by surgery within 8 months were included. Predictors of npCR were modeled with multivariable logistic regression.

In total, 47,483 patients were included: 18,978 (40.0%) with npCR and 28,505 (60.0%) with nodal residual disease (nRD). Median age for the npCR group was 53 years (interquartile range [IQR] 21-90 years) compared with 54 years (IQR 21-90 years, p < 0.001) in the nRD group. Triple negative breast cancer (TNBC) was the most common subtype (53.5%) in the npCR group while ER+/HER2- was the most common (46.5%) in the nRD group, p < 0.001. After adjusting for sociodemographic factors, comorbidities, tumor characteristics, and treatment, younger age (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-0.99), ER-/HER2+ compared with TNBC (OR 1.32, 95% CI 1.21-1.44), and receipt of immunotherapy (OR 1.60, 95% CI 1.46-1.74) were associated with npCR. Black patients were less likely to have npCR overall (OR 0.90, 95% CI 0.85-0.95) with TNBC and HER2+ tumors, but more likely in ER+/HER2- tumors.

Both tumor and sociodemographic factors were associated with npCR in patients with BC. Black compared with white patients were more likely to have npCR in the ER+/HER2- subtype but less likely in the hormone receptor-negative and HER2+ subtypes. Mechanisms underlying these differences should be further investigated.