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Predictors of Axillary Complete Pathologic response in Hormone Receptor Positive, HER2 Negative Clinically

Christina Layton1, Anshumi Desai1, Youley Tjendra1

  • 1University of Miami, USA.

European Journal of Breast Health
|April 9, 2026
PubMed
Summary

Neoadjuvant therapy can improve axillary complete pathologic response (cPR) in node-positive breast cancer patients. Lower clinical stage (II) was associated with higher cPR rates, potentially avoiding axillary dissection.

Keywords:
Predictorscomplete pathologic responseluminal node positive

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Area of Science:

  • Oncology
  • Breast Cancer Research
  • Neoadjuvant Therapy

Background:

  • Neoadjuvant therapy can downstage the axilla, potentially reducing the need for axillary dissection.
  • Achieving a complete pathologic response (cPR) in the axilla correlates with improved long-term survival.
  • Previous studies had small cohorts, limiting the investigation of predictors for axillary response.

Purpose of the Study:

  • To expand a previous cohort of patients with hormone receptor-positive, HER2-negative, clinically node-positive breast cancer.
  • To evaluate potential demographic and clinicopathologic predictors of axillary cPR after neoadjuvant therapy.
  • To identify factors associated with response to neoadjuvant endocrine or chemotherapy.

Main Methods:

  • Retrospective cohort study of 200 patients treated between January 2011 and December 2022.
  • Inclusion criteria: hormone receptor-positive, HER2-negative, clinically node-positive breast cancer.
  • Analysis included Chi-square/Fisher's exact tests for categorical variables and t-tests for continuous variables.

Main Results:

  • Axillary cPR was achieved in 12% (n=24) of patients; 88% (n=176) had no axillary cPR.
  • Higher cPR rates were observed in clinical Stage II patients (20%) compared to Stage III (7.8%) (p=0.013).
  • Patients with axillary cPR had fewer lymph nodes removed during surgery (8 vs. 16, p=0.001).

Conclusions:

  • Lower clinical stage (Stage II) is a predictor of higher axillary cPR in this patient group.
  • Achieving cPR allows patients to potentially avoid axillary dissection.
  • A larger patient cohort is needed to further define predictors of response to neoadjuvant therapy.