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Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China

  • Original Article – Cancer Research
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Abstract

Purpose

Studies show that axillary surgery can be potentially omitted in certain breast cancer patients who achieve breast pathologic complete response (pCR) after neoadjuvant systemic therapy (NST). However, potential differences between the ypT0 and ypTis subgroups remain to be explored. Furthermore, whether axillary surgery can be omitted in patients with clinically assessed positive axillary lymph nodes (cN+) remains unknown. This study was to evaluate the status of axillary lymph nodes for patients who achieved breast pCR after NST in the real-world study.

Methods

This retrospective cohort study included 258 patients with early or locally advanced breast cancer who underwent breast and axillary surgery after NST. Clinical and pathologic data were compared between patients with breast pCR (ypT0/is) and those without breast pCR.

Results

The rate of breast pCR after NST was 27.1% (70/258). Among the patients with initial cN0, the rate of axillary pCR was similar between the breast pCR and breast non-pCR groups (100% vs. 85.7%, P = 0.1543). Among those with breast pCR, the rate of axillary pCR was 100% in both the ypT0 and ypTis subgroups. Furthermore, among those with initial cN+, the rate of axillary pCR was higher in the breast pCR group than in the breast non-pCR group (82.7% vs. 22.9%, P < 0.0001). Among the patients with breast pCR, the rate of axillary pCR was higher in the ypT0 subgroup than in the ypTis subgroup (94.3% vs. 58.8%, P = 0.0034).

Conclusion

Axillary surgery may potentially be omitted in patients with initial cN0 who achieve breast pCR (ypT0/is), and may also be considered for omission in patients with initial cN+ who achieve ypT0 (not ypTis).

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Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This research was supported in part by Jiangsu Province Six Talents Summit Project (WSW-001), Youth Talent Project (FRC201308), Jiangsu Women and Children Health Research Project (F201761), Chinese Society of Clinical Oncology Foundation (Y-sy2018-077, Y-JS2019-096), National Natural Science Foundation of China (81302305), Natural Science Foundation of Jiangsu Province (BK20131027), Jiangsu Province Women and Children Health Scientific Research Project (F201821).

Funding

The authors received no financial support for the research, and/or publication of this article.

Author information

Authors and Affiliations

  1. Breast Disease Department, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Rui Chen, Shuo Li, Yan Li, Qiannan Zhu, Xiaoqing Shi, Yinggang Xu, Weiwei Zhang, Xiaofeng Huang, Jue Wang & Xiaoming Zha

  2. Clinical Nutrition Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China

    Lu Xu

  3. Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 210000, China

    Jue Wang & Xiaoming Zha

Authors
  1. Rui Chen
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  2. Shuo Li
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  3. Yan Li
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  4. Qiannan Zhu
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  5. Xiaoqing Shi
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  6. Lu Xu
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  7. Yinggang Xu
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  8. Weiwei Zhang
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  9. Xiaofeng Huang
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  10. Jue Wang
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  11. Xiaoming Zha
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Contributions

XZ and JW designed this study and conducted quality control on it. RC, YL, and XS participated in the analysis of data and drafted the manuscript. SL, QZ, LX, YX, WZ and XH were responsible for data collection. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jue Wang or Xiaoming Zha.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

All the procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and those of the Helsinki Declaration. This work was approved by the ethics and research committee of the First Affiliated Hospital of Nanjing Medical University (2020-SR-081), and informed consent was obtained from all the participants.

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Chen, R., Li, S., Li, Y. et al. Can axillary surgery be omitted in patients with breast pathologic complete response after neoadjuvant systemic therapy for breast cancer? A real-world retrospective study in China. J Cancer Res Clin Oncol 147, 3495–3501 (2021). https://doi.org/10.1007/s00432-021-03763-8

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  • DOI: https://doi.org/10.1007/s00432-021-03763-8

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