Abstract：
BACKGROUND: Clinical trial data indicate that omitting axillary lymph node dissection (ALND) is feasible and may reduce morbidity for carefully selected patients with clinically node-positive breast cancer who achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NCT). However, there remains a need to understand how these findings translate to broader clinical practice and to identify which patients benefit most. This study utilizes a national dataset to assess outcomes in axillary management, aiming to inform best practice in axillary de-escalation.
METHODS: The National Cancer Data Base was used to identify women diagnosed with clinically node-positive invasive breast cancer between 2012 to 2020 who received NCT and subsequent ALND. Associations between clinicopathologic factors and axillary pCR were analyzed statistically.
RESULTS: Of the 59,791 patients included, 8,827 (14.76%) achieved nodal pCR. Patients with HR-negative and HER2-positive receptor status more frequently underwent ALND instead of sentinel lymph node biopsy. Conversely, patients over the age of 70, those with private or public insurance, and cases classified as ypT1 or ypT2 were less likely to undergo ALND.
CONCLUSIONS: A subset of patients with clinically node-positive breast cancer received ALND despite achieving axillary pCR following NCT. This highlights an opportunity to enhance precision in identifying candidates for axillary de-escalation, potentially reducing morbidity and tailoring treatment more closely to individual patient needs.
METHODS: The National Cancer Data Base was used to identify women diagnosed with clinically node-positive invasive breast cancer between 2012 to 2020 who received NCT and subsequent ALND. Associations between clinicopathologic factors and axillary pCR were analyzed statistically.
RESULTS: Of the 59,791 patients included, 8,827 (14.76%) achieved nodal pCR. Patients with HR-negative and HER2-positive receptor status more frequently underwent ALND instead of sentinel lymph node biopsy. Conversely, patients over the age of 70, those with private or public insurance, and cases classified as ypT1 or ypT2 were less likely to undergo ALND.
CONCLUSIONS: A subset of patients with clinically node-positive breast cancer received ALND despite achieving axillary pCR following NCT. This highlights an opportunity to enhance precision in identifying candidates for axillary de-escalation, potentially reducing morbidity and tailoring treatment more closely to individual patient needs.
摘要：
背景：临床试验数据表明，对于精心选择的临床淋巴结阳性乳腺癌患者，在新辅助化疗（NCT）后达到病理完全缓解（pCR），省略腋窝淋巴结清扫术（ALND）是可行的，并且可以降低发病率。然而,仍然需要了解这些发现如何转化为更广泛的临床实践,并确定哪些患者受益最大.本研究利用国家数据集来评估腋窝管理的结果，旨在为腋窝降级提供最佳实践。
方法：国家癌症数据库用于识别2012年至2020年间诊断为临床淋巴结阳性浸润性乳腺癌并接受NCT和随后的ALND的女性。对临床病理因素与腋窝pCR的关系进行统计学分析。
结果：在59,791名患者中，8,827（14.76%）实现了节点pCR。HR阴性和HER2阳性受体状态的患者更频繁地接受ALND而不是前哨淋巴结活检。相反，70岁以上的患者，有私人或公共保险的患者，分类为ypT1或ypT2的病例不太可能接受ALND。
结论：一部分临床淋巴结阳性乳腺癌患者接受了ALND，尽管在NCT后达到了腋窝pCR。这凸显了提高识别腋窝降级候选者的准确性的机会，有可能降低发病率，并根据个体患者的需求调整治疗方案。
方法：国家癌症数据库用于识别2012年至2020年间诊断为临床淋巴结阳性浸润性乳腺癌并接受NCT和随后的ALND的女性。对临床病理因素与腋窝pCR的关系进行统计学分析。
结果：在59,791名患者中，8,827（14.76%）实现了节点pCR。HR阴性和HER2阳性受体状态的患者更频繁地接受ALND而不是前哨淋巴结活检。相反，70岁以上的患者，有私人或公共保险的患者，分类为ypT1或ypT2的病例不太可能接受ALND。
结论：一部分临床淋巴结阳性乳腺癌患者接受了ALND，尽管在NCT后达到了腋窝pCR。这凸显了提高识别腋窝降级候选者的准确性的机会，有可能降低发病率，并根据个体患者的需求调整治疗方案。
