Pathology of axillary lymph nodes after neoadjuvant chemotherapy for human epidermal growth factor receptor 2-positive and triple-negative breast cancer patients
Objective To investigate the pathology of axillary lymph nodes after neoadjuvant chemotherapy(NAC)for human epidermal growth factor receptor 2(HER2)positive and triple-negative breast cancer and analyze the influencing fac-tors of pathologically positive(ypN0)axillary lymph nodes.Methods The clinical data of 72 patients with HER2-positive and triple-negative breast cancer admitted to the Xi'an International Medical Center Hospital from September 2019 to January 2022 were retrospectively analyzed,including 35 patients with HER2-positive breast cancer and 37 patients with triple-negative breast cancer.According to the pathology of axillary lymph nodes after NAC,the patients were divided into the ypN0 group(n=41)and the non-ypN0 group(n=31).The menopausal status,pathological type,breast cancer type,NAC duration,maxi-mum tumor diameter,tumor staging before NAC,lymph node staging before NAC,breast radiologic complete response(brCR)after NAC,clinically negative lymph node(cN0)after NAC,and pathologic complete response(pCR)of primary tumor after NAC were compared between the two groups.The independent factors influencing ypN0 after NAC in HER2-positive and triple-negative breast cancer patients were analyzed using the multivariate logistic regression,and the ypN0 status of patients with lymph node stages cN0 and cN1 before NAC was also analyzed.Results There were no significant differences in menopausal status,pathological type,breast cancer type,NAC duration and maximum tumor diameter between the ypN0 group and the non-ypN0 group(P＞0.05).There were statistically significant differences between the ypN0 group and the non-ypN0 group in tumor staging before NAC,lymph node staging before NAC,brCR of primary tumor after NAC,cN0 after NAC,and pCR of pri-mary tumor after NAC(P＜0.05).The multivariate logistic regression analysis showed that lymph node staging before NAC,lymph node cN0 after NAC,and pCR of primary tumor after NAC were independent factors affecting ypN0 after NAC in HER2-positive and triple-negative breast cancer patients(P＜0.05).Among the 14 cN0 patients before NAC,6 achieved pCR and 8 did not achieve pCR after NAC.The ypN0 rate between patients who achieved pCR[100％(6/6)]and patients who did not achieve pCR[75％(6/8)]after NAC had no significant difference(x2=1.750,P=0.186).Among the 33 cN1 patients be-fore NAC,10 achieved pCR and 23 did not achieve pCR after NAC.The ypN0 rate in patients with pCR after NAC[100％(10/10)]was higher than that in patients without pCR[39.13％(9/23)](x2=10.572,P=0.001).Conclusion For HER2-positive and triple-negative breast cancer patients,the lymph node staging before NAC,lymph node cN0 after NAC,and primary tumor pCR after NAC are related to the pathology of axillary lymph nodes.All cN0 patients and some cN1 patients with pCR after NAC have a low risk of axillary metastasis,and axillary de-escalation surgery can be considered.
human epidermal growth factor receptor 2 positive breast cancertriple-negative breast cancerneoadjuvant chemotherapyaxillary lymph node
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