Predictive factors for axillary pathological complete response in initially node-positive breast cancer patients treated with neoadjuvant therapy
Objective:To identify the predictive factors for axillary pathological complete response (apCR) in initially node-positive (cN+) breast cancer patients treated with neoadjuvant treatment (NAT).Methods:Data of cN+ breast cancer patients treated with NAT at the Breast Department of Sichuan Cancer Hospital from June 2016 to April 2023 were retrospectively reviewed. Clinicopathological characteristics were compared between patients with and without apCR. Univariate and multivariate analyses were conducted for identifying the predictive factors for apCR.Results:A total of 486 patients were included and the overall apCR rate was 50.4% (245/486). In the univariate analysis, histological grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 index, clinical response, and breast pathological complete response (bpCR) were associated with apCR (P<0.05). Multivariate analysis demonstrated that HER2 positivity (P<0.001), better clinical response, (P=0.047), and bpCR (P<0.001) were independent predictors of apCR. The area under the receiver operating characteristic curve of the prediction model of apCR in cN+ breast cancer patients treated with NAT was 0.793 (95% confidence interval: 0.753-0.833), with a sensitivity of 68.0% and specificity of 81.1%.Conclusion:In cN+ breast cancer patients treated with NAT, those with HER2 positive disease, better clinical response, or bpCR have a lower risk of axillary residual disease, and can be candidates for de-escalating surgical research.
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