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Nodal Pathologic Response to Neoadjuvant Systemic Therapy in Clinical N2 and N3 Nonmetastatic Breast Cancer
Diana M Jaen1, Collin E Dougherty1, Kimberly A Helseth1
1Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
The Journal of Surgical Research
|July 11, 2026
Summary
Over 40% of patients with advanced breast cancer (cN2/cN3) achieved a complete response in lymph nodes after neoadjuvant systemic therapy (NST). Factors like HER2-positive status and complete breast response (ypT0) predict nodal response, aiding surgical de-escalation decisions.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Axillary lymph node dissection is standard for cN2/cN3 breast cancer post-neoadjuvant systemic therapy (NST).
- Some patients achieve nodal pathologic complete response (ypN0) and may be candidates for de-escalation.
- Nodal response patterns after NST in this population require further definition.
Purpose of the Study:
- To determine the frequency of ypN0 in patients with cN2/cN3 breast cancer after NST.
- To identify clinicopathologic factors associated with achieving ypN0.
Main Methods:
- Retrospective cohort study of institutional cancer registry (2018-2024).
- Included women with cT1-T4, N2-N3, no distant metastasis breast cancer receiving NST and axillary lymph node dissection.
- Compared demographic, clinical, and tumor characteristics between ypN0 and ypN+ groups.
Main Results:
- 15 of 37 (40.5%) patients achieved ypN0; 22 (59.5%) had residual nodal disease.
- Human epidermal growth factor receptor 2 (HER2)-positive tumors showed a higher ypN0 rate (P=0.026).
- Breast pathologic complete response (ypT0) was strongly associated with ypN0 (66.7% vs 4.5%, P<0.001).
Conclusions:
- Over 40% of cN2/cN3 breast cancer patients achieve ypN0 after NST.
- HER2-negative tumors and absence of ypT0 were associated with residual nodal disease.
- Younger age trended towards improved nodal response, suggesting factors for individualized surgical de-escalation.