Background: Neoadjuvant therapy (NAT) plays a crucial role in breast cancer (BC) management by enabling tumor and nodal downstaging. While axillary lymph node dissection (ALND) remains the standard for patients with residual nodal disease after NAT, its prognostic benefit is debated. Identifying predictors of high-burden residual axillary disease may guide treatment intensification and surgical de-escalation strategies. Methods: We retrospectively analyzed 262 BC patients treated with NAT followed by ALND between 2006 and 2023. Patients were stratified into low- (ypN0-mi-1) and high-burden (ypN2-3) residual axillary disease groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of high-burden residual disease. Results: High-burden residual axillary disease was observed in 35.9% of patients. Baseline cN+ status (OR = 7.697,p= 0.013), HR+/HER2− subtype (OR = 3.945,p= 0.003), and larger post-NAT tumor size (OR = 1.043,p< 0.001) were independent predictors. Conclusions: Identifying patients at risk of high-burden residual axillary disease is essential to optimize neoadjuvant strategies. Increasing axillary pathological complete response may reduce the need for ALND, minimizing surgical morbidity without compromising oncological outcomes.
背景：新辅助治疗（NAT）通过实现肿瘤和淋巴结降期，在乳腺癌（BC）管理中发挥着关键作用。虽然对于NAT后仍有残留淋巴结病变的患者，腋窝淋巴结清扫术（ALND）仍是标准治疗，但其预后获益存在争议。识别高负荷残留腋窝病变的预测因子，可能有助于指导强化治疗和手术降阶梯策略。 方法：我们回顾性分析了2006年至2023年间接受NAT后行ALND的262例BC患者。根据残留腋窝病变负荷将患者分为低负荷组（ypN0-mi-1）和高负荷组（ypN2-3）。通过单因素和多因素逻辑回归分析，确定高负荷残留病变的独立预测因子。 结果：35.9%的患者观察到高负荷残留腋窝病变。基线cN+状态（OR = 7.697，p= 0.013）、HR+/HER2−亚型（OR = 3.945，p= 0.003）以及NAT后较大的肿瘤尺寸（OR = 1.043，p< 0.001）是独立的预测因子。 结论：识别存在高负荷残留腋窝病变风险的患者对于优化新辅助治疗策略至关重要。提高腋窝病理完全缓解率可能减少对ALND的需求，从而在不影响肿瘤学结局的前提下，最大限度地降低手术相关并发症。
Predictors of High-Burden Residual Axillary Disease After Neoadjuvant Therapy in Breast Cancer
肿瘤(癌症)患者之家