Neoadjuvant systemic treatment (NST) is the standard treatment for HER2+, triple-negative (TN), and highly proliferative luminal HER2− early breast cancer. Pathologic complete response (pCR) after NST is associated with improved outcomes. We evaluated the predictive factors for axillary-pCR (AXpCR) and its impact on the extent of axillary node surgery. This retrospective study included 92 patients (median age of 50.4 years) with an initially node-positive disease. Patients were treated with molecular subtype-specific NST (4.3% were luminal A-like, 28.3% luminal HER2−, 26.1% luminal HER2+, 18.5% HER2+ non-luminal, and 22.8% TN). Axillary-, breast- and total-pCR were achieved in 52.2%, 48.9%, and 38% of patients, respectively. In a binary logistic regression model for the whole population, the only independent factor significantly associated with AXpCR was breast-pCR (OR 7.4; 95% CI 2.6–20.9;p< 0.001). In patients who achieved breast-pCR, aggressive subtypes (HER2+ and TN; OR 11.24) and clinical tumor stage (OR 0.10) had a significant impact on achieving AXpCR. Axillary lymph node dissection was avoided in 53.3% of patients. In conclusion, in node-positive patients with HER2+ and TN subtypes, who achieved breast-pCR after NST, de-escalation of axillary surgery could be considered in most cases.
新辅助全身治疗（NST）是HER2阳性、三阴性（TN）以及高增殖性Luminal HER2阴性早期乳腺癌的标准治疗方案。NST后达到病理完全缓解（pCR）与改善预后相关。本研究评估了腋窝病理完全缓解（AXpCR）的预测因素及其对腋窝淋巴结手术范围的影响。这项回顾性研究纳入了92例初始淋巴结阳性的患者（中位年龄50.4岁），均接受了分子亚型特异性NST治疗（其中Luminal A样型占4.3%，Luminal HER2阴性型28.3%，Luminal HER2阳性型26.1%，HER2阳性非Luminal型18.5%，三阴性型22.8%）。腋窝pCR、乳腺pCR和总体pCR的实现率分别为52.2%、48.9%和38%。在全人群的二元逻辑回归模型中，与AXpCR显著相关的唯一独立因素是乳腺pCR（比值比7.4；95%置信区间2.6–20.9；p<0.001）。在实现乳腺pCR的患者中，侵袭性亚型（HER2阳性与三阴性；比值比11.24）和临床肿瘤分期（比值比0.10）对实现AXpCR具有显著影响。53.3%的患者避免了腋窝淋巴结清扫术。综上所述，对于HER2阳性和三阴性亚型、且在NST后实现乳腺pCR的淋巴结阳性患者，在大多数情况下可考虑实施腋窝手术降阶梯治疗。
肿瘤(癌症)患者之家