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Can neoadjuvant endocrine therapy de-escalate surgery in luminal breast cancer? A four-year retrospective study from
Aleksander Skulimowski1, Jakub Skórniak1,2, Tomasz Michalik1
1Breast Unit, II Department of Surgical Oncology, Lower Silesian Center of Oncology, Pulmonology, and Hematology, Wroclaw, Poland.
Introduction:
Postmenopausal women commonly present with HR-positive/HER2-negative breast cancer. Neoadjuvant endocrine therapy (NET) may facilitate breast-conserving surgery (BCS) and de-escalation of axillary surgery. This study evaluated NET efficacy in enabling surgical de-escalation in luminal breast cancer.
Materials And Methods:
A retrospective study included postmenopausal women (≥49 years) with newly diagnosed, luminal breast cancer treated with NET between May 2021 and May 2024 at a single tertiary breast unit. Patients with stage IV disease or contraindications to surgery were excluded. Clinical and pathologic variables were collected from chart review. Tumor and nodal downstaging were defined by decrease of at least one level from clinical (cT or cN) to pathologic (ypT or ypN) stage. Multivariable logistic regression was used to identify predictors of downstaging.
Results:
A total of 124 patients (128 tumors) were included. Mean age at diagnosis was 69 years. NET resulted in a significant reduction in tumor size (mean absolute reduction 10.93 mm; p < 0.0001; mean relative reduction 23.4%; p < 0.0001). BCS was achieved in 75.8% of cases, and NET was estimated to have avoided mastectomy in at least 27 patients. Lobular histology (OR 2.92, 95% CI 1.20-7.00; p = 0.017) and absence of clinical nodal involvement (OR 3.10, 95% CI 1.45-6.55; p = 0.003) were independently associated with T-stage downstaging.Regarding axillary management, 75.8% underwent sentinel lymph node biopsy and 22.7% upfront axillary lymph node dissection. Among patients initially managed with SLNB, 35% required completion ALND. Of 60 clinically node-positive (cN1) patients, 8 (12.7%) achieved ypN0 status after NET. Micrometastatic residual disease was observed in 4 additional cases (6.3% of cN1 patients).
Conclusions:
NET effectively facilitates breast-conserving surgery in postmenopausal patients with luminal breast cancer. However, its impact on achieving nodal clearance and reducing axillary dissection remains limited.
